Healthcare Provider Details

I. General information

NPI: 1497006563
Provider Name (Legal Business Name): ASI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 W. ARMITAGE AVE.
CHICAGO IL
60647-4208
US

IV. Provider business mailing address

2619 W. ARMITAGE AVE.
CHICAGO IL
60647-4208
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-5130
  • Fax: 773-278-1380
Mailing address:
  • Phone: 773-278-5130
  • Fax: 773-278-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA CRUZ
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 773-278-5130