Healthcare Provider Details

I. General information

NPI: 1053714550
Provider Name (Legal Business Name): NURSES ON WHEELS HOMESERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 PAVONE ST
BENTON HARBOR MI
49022-5124
US

IV. Provider business mailing address

907 DARTMOUTH AVE
MATTESON IL
60443-1514
US

V. Phone/Fax

Practice location:
  • Phone: 773-742-8433
  • Fax:
Mailing address:
  • Phone: 773-742-8433
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ALESIA BOYD
Title or Position: DIRECTOR
Credential:
Phone: 773-742-8433