Healthcare Provider Details

I. General information

NPI: 1730527896
Provider Name (Legal Business Name): CARE BRIDGE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9865 WEST ROOSEVELT RD. SUITE # 204
WESTCHESTER IL
60154
US

IV. Provider business mailing address

9865 WEST ROOSEVELT RD. SUITE # 204
WESTCHESTER IL
60154
US

V. Phone/Fax

Practice location:
  • Phone: 708-582-7595
  • Fax: 708-343-3632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: EVELYN B. CARREON
Title or Position: PRESIDENT/DIRECTOR OF NURSING
Credential:
Phone: 630-674-0464