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General NPI Number Information
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NPI Number | 1730500315
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Entity Type | Organization
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Legal Business Name | ILLINOIS CARE AND TRAINING INC.
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Dates
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Enumeration Date | 12/26/2013
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 4554 N BROADWAY ST STE 314
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City | CHICAGO
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State | IL
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Zip | 60640-5621
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Country | US
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Telephone | 773-271-4110
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Fax | 773-784-5154
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Provider Business Mailing Address
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Address Line | 4554 N BROADWAY ST STE 314
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City | CHICAGO
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State | IL
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Zip | 60640-5621
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Country | US
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Telephone | 773-271-4110
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Fax | 773-784-5154
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDDIE N, NWOSU
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Credential |
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Telephone | 773-271-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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