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General NPI Number Information
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NPI Number | 1417771882
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Entity Type | Organization
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Legal Business Name | LINDA & JESSIE CARE HOMES INC.
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1447 W 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60643-2952
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Country | US
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Telephone | 773-701-6387
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Fax |
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Provider Business Mailing Address
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Address Line | 1447 W 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60643-2952
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Country | US
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Telephone | 773-957-4064
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LATRICE DUNKINSEL DAVIS
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Credential | RN
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Telephone | 773-957-4064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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