Healthcare Provider Details

I. General information

NPI: 1013241066
Provider Name (Legal Business Name): COMFORT COMPANION CHOICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 HARRISON ST SUITE 206
OAK PARK IL
60304-1144
US

IV. Provider business mailing address

818 HARRISON ST SUITE 206
OAK PARK IL
60304-1144
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-3324
  • Fax: 708-386-3397
Mailing address:
  • Phone: 708-386-3324
  • Fax: 708-386-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. LA SHON GURROLA
Title or Position: OWNER/ PROGRAM DIRECTOR
Credential: RN
Phone: 708-386-3324