Healthcare Provider Details

I. General information

NPI: 1891532073
Provider Name (Legal Business Name): BEWELL HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2024
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 W PETERSON AVE STE 500
CHICAGO IL
60659-3317
US

IV. Provider business mailing address

13139 CLEVELAND ST
CROWN POINT IN
46307-2026
US

V. Phone/Fax

Practice location:
  • Phone: 773-704-4102
  • Fax: 773-754-8705
Mailing address:
  • Phone: 773-704-4102
  • Fax: 773-754-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. MA LORELA QUERIMIT
Title or Position: PRESIDENT
Credential: RN, BSN
Phone: 773-704-4102