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General NPI Number Information
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NPI Number | 1538170345
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Entity Type | Organization
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Legal Business Name | GREAT PARAGON HEALTH CARE INC.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 2640 W TOUHY AVE STE. 205-206
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City | CHICAGO
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State | IL
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Zip | 60645-3198
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Country | US
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Telephone | 773-274-7694
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Fax | 773-274-9082
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Provider Business Mailing Address
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Address Line | 2640 W TOUHY AVE STE. 205-206
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City | CHICAGO
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State | IL
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Zip | 60645-3198
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Country | US
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Telephone | 773-274-7694
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Fax | 773-274-9082
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Authorized Official
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Title or Position | DIRECTOR/ADMINISTRATOR
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Name | MRS. AIWUYO RITA OBASEKI
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Credential | RN
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Telephone | 773-274-7694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010583
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License Number State | IL
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