Healthcare Provider Details

I. General information

NPI: 1780436402
Provider Name (Legal Business Name): THE IMMACULATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 S HALSTED ST STE 1
CHICAGO IL
60608-6169
US

IV. Provider business mailing address

2124 S HALSTED ST STE 1
CHICAGO IL
60608-6169
US

V. Phone/Fax

Practice location:
  • Phone: 312-585-7400
  • Fax:
Mailing address:
  • Phone: 312-585-7400
  • Fax: 312-585-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AKINWUMI AKINSEYE
Title or Position: AGENCY MANAGER
Credential:
Phone: 312-585-7400