Healthcare Provider Details

I. General information

NPI: 1396424073
Provider Name (Legal Business Name): ABSOLUTECARE TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17105 LAFLIN AVE # 2W
EAST HAZEL CREST IL
60429-1854
US

IV. Provider business mailing address

18227 OLDE FARM RD
LANSING IL
60438-2553
US

V. Phone/Fax

Practice location:
  • Phone: 708-965-2633
  • Fax:
Mailing address:
  • Phone: 708-965-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
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 TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JALEN WINSTON
Title or Position: PRESIDENT
Credential:
Phone: 708-965-2633