Healthcare Provider Details

I. General information

NPI: 1528635463
Provider Name (Legal Business Name): SAFE CARE ASSISTANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 N PARKSIDE AVE
CHICAGO IL
60644-1547
US

IV. Provider business mailing address

646 N PARKSIDE AVE
CHICAGO IL
60644-1547
US

V. Phone/Fax

Practice location:
  • Phone: 708-965-1151
  • Fax:
Mailing address:
  • Phone: 708-965-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. EARNESTINE MOORE
Title or Position: UNKNOWN
Credential:
Phone: 708-965-1151