Healthcare Provider Details

I. General information

NPI: 1720782659
Provider Name (Legal Business Name): UNIVERSAL HEALTHCARE STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 FOREST BLVD
PARK FOREST IL
60466-2005
US

IV. Provider business mailing address

338 FOREST BLVD
PARK FOREST IL
60466-2005
US

V. Phone/Fax

Practice location:
  • Phone: 708-265-3064
  • Fax:
Mailing address:
  • Phone: 708-265-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MISS SOPHIA BRACEY
Title or Position: MANAGER
Credential: RN
Phone: 708-668-8589