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General NPI Number Information
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NPI Number | 1275089773
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Entity Type | Organization
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Legal Business Name | JES-ROYAL HOMECARE
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 4747 S PRINCETON AVE FIRST FLOOR
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City | CHICAGO
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State | IL
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Zip | 60609-4544
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Country | US
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Telephone | 773-355-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 4747 S PRINCETON AVE FIRST FLOOR
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City | CHICAGO
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State | IL
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Zip | 60609-4544
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABIODUN AJAYI
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Credential |
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Telephone | 773-886-4312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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