=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033081195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURPLE PLUSH DYNASTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2025
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 E 66TH PL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60637-4422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-766-1677
-----------------------------------------------------
Fax | 888-649-2858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1440 W TAYLOR ST # 993
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-259-1459
-----------------------------------------------------
Fax | 888-649-2858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. IVY MARIE WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-259-1459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------