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General NPI Number Information
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NPI Number | 1639594559
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Entity Type | Organization
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Legal Business Name | SSANJJEMMA CARE PROVIDER INC.
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 3622 SALEM WALK APT A2
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City | NORTHBROOK
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State | IL
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Zip | 60062-7331
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Country | US
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Telephone | 773-495-9668
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Fax |
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Provider Business Mailing Address
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Address Line | 3622 SALEM WALK APT A2
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City | NORTHBROOK
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State | IL
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Zip | 60062-7331
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Country | US
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Telephone | 773-495-9668
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. SUSAN J. TOQUE
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Credential |
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Telephone | 773-495-9668
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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 |
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License Number State | IL
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