=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144985987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUELLA HEALTH SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2021
-----------------------------------------------------
Last Update Date | 11/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 N LAMON AVE # 1N
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60651-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-664-7520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 N LAMON AVE # 1N
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60651-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-664-7520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNA
-----------------------------------------------------
Name | MS. LUELLA GREER
-----------------------------------------------------
Credential | CERTIFIED NURSING AS
-----------------------------------------------------
Telephone | 312-970-6351
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------