Healthcare Provider Details

I. General information

NPI: 1932865953
Provider Name (Legal Business Name): ECO LOGISTICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 11/14/2021
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 W JEROME ST
CHICAGO IL
60645-1543
US

IV. Provider business mailing address

2535 W JEROME ST APT A
CHICAGO IL
60645-1544
US

V. Phone/Fax

Practice location:
  • Phone: 312-731-3678
  • Fax:
Mailing address:
  • Phone: 312-731-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: IDOWU OLORUNSOLA
Title or Position: MANAGER
Credential:
Phone: 312-731-3678