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General NPI Number Information
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NPI Number | 1528631561
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Entity Type | Organization
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Legal Business Name | ANOVA HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 1134 E 152ND ST
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City | DOLTON
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State | IL
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Zip | 60419-2884
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Country | US
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Telephone | 773-225-9417
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Fax |
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Provider Business Mailing Address
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Address Line | 1252 S FEDERAL ST UNIT C
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City | CHICAGO
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State | IL
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Zip | 60605-4901
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Country | US
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Telephone | 773-225-9417
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | SEUN SOLESI
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Credential | MBA
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Telephone | 773-225-9417
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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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