=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336941608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILES OF CARE - WEST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10408 S WESTERN AVE STE D
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60643-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-438-2525
-----------------------------------------------------
Fax | 708-933-3459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 19111
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60619-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-438-2525
-----------------------------------------------------
Fax | 708-933-3459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS MGR
-----------------------------------------------------
Name | TAMMISHIA LITTLE
-----------------------------------------------------
Credential | NURSE
-----------------------------------------------------
Telephone | 844-438-2525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------