=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336547488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSHUA ALLIED HOME HEALTH CORPORATION NFP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2014
-----------------------------------------------------
Last Update Date | 12/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4250 N MARINE DR APT 2534
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60613-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-458-7527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4250 N MARINE DR APT 2534
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60613-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-458-7527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DIRECTOR
-----------------------------------------------------
Name | GERVASE BOLDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-458-7527
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------