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General NPI Number Information
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NPI Number | 1750914511
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Entity Type | Individual
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Provider Name | CLARENCE BEALS
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Gender | Male
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 5943 S ABERDEEN ST
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City | CHICAGO
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State | IL
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Zip | 60621-1429
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Country | US
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Telephone | 773-498-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 5726 S SANGAMON ST
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City | CHICAGO
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State | IL
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Zip | 60621-2238
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Country | US
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Telephone | 312-513-7857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 05554151
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License Number State | IL
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