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General NPI Number Information
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NPI Number | 1659190700
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Entity Type | Organization
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Legal Business Name | MOBILEMOGULRURALHEALTHCLINIC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 35236 N WILSON RD
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City | INGLESIDE
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State | IL
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Zip | 60041
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Country | US
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Telephone | 262-504-0241
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | FAIRFIELD
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State | CA
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Zip | 94533-0006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DORIS V WALKER
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Credential | CDCP
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Telephone | 262-504-0241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #5
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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 |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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