Healthcare Provider Details

I. General information

NPI: 1245894088
Provider Name (Legal Business Name): LUCY'S HOME CARE EXPRESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 GRAND AVE
WAUKEGAN IL
60085-3315
US

IV. Provider business mailing address

2424 GRAND AVE STE 2
WAUKEGAN IL
60085-3315
US

V. Phone/Fax

Practice location:
  • Phone: 847-599-8181
  • Fax: 847-672-8943
Mailing address:
  • Phone: 847-599-8181
  • Fax: 847-672-8943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: LUCILIA RIOS
Title or Position: CEO/ADMINISTRATOR
Credential: CSCM,CDP
Phone: 847-599-8181