=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154190734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHICARE TRANSPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2023
-----------------------------------------------------
Last Update Date | 12/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 W PETERSON AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-946-0566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 W PETERSON AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ABDURAHMAN JALALOOTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-946-0566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------