=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114696564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UCCT CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2021
-----------------------------------------------------
Last Update Date | 09/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 269 NORWAY DR
-----------------------------------------------------
City | BARTLETT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-659-1993
-----------------------------------------------------
Fax | 847-893-6183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 269 NORWAY DR
-----------------------------------------------------
City | BARTLETT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-659-1993
-----------------------------------------------------
Fax | 847-893-6183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE MANAGER
-----------------------------------------------------
Name | ADA OGUEJIOFOR
-----------------------------------------------------
Credential | RN BSN
-----------------------------------------------------
Telephone | 224-659-1993
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------