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General NPI Number Information
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NPI Number | 1336866169
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Entity Type | Individual
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Provider Name | JERRY MASANGCAY
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Gender | Male
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 121 FAIRFIELD WAY STE 106B
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1555
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Country | US
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Telephone | 630-283-0393
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Fax | 847-466-7068
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Provider Business Mailing Address
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Address Line | 4926 CRAIN ST UNIT C
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City | SKOKIE
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State | IL
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Zip | 60077-5444
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Country | US
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Telephone | 847-466-7069
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Fax | 630-283-0343
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 3001932
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | INH2202079
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 3001932
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License Number State | IL
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