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General NPI Number Information
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NPI Number | 1679818215
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Entity Type | Organization
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Legal Business Name | BRONZE KEY, LLC
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Dates
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Enumeration Date | 12/09/2012
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Last Update Date | 12/09/2012
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Provider Practice Location Address
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Address Line | 3849 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60653-1513
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Country | US
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Telephone | 312-929-0999
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Fax | 312-674-7550
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Provider Business Mailing Address
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Address Line | 3849 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60653-1513
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Country | US
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Telephone | 312-929-0999
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Fax | 312-674-7550
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Authorized Official
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Title or Position | AGENCY ADMINISTRATOR
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Name | MR. GREGORY A MURPHY
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Credential | RN
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Telephone | 312-929-0999
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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 | 1011528
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License Number State | IL
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