Healthcare Provider Details

I. General information

NPI: 1568040012
Provider Name (Legal Business Name): ALL AMERICAN VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 E DEMPSTER ST STE 115
DES PLAINES IL
60016-5315
US

IV. Provider business mailing address

2454 E DEMPSTER ST STE 115
DES PLAINES IL
60016-5315
US

V. Phone/Fax

Practice location:
  • Phone: 312-998-5756
  • Fax:
Mailing address:
  • Phone: 312-998-5756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SAM ALLAM
Title or Position: MANAGER
Credential:
Phone: 312-998-5756