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General NPI Number Information
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NPI Number | 1770899890
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Entity Type | Organization
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Legal Business Name | ICOCO ENTERPRISES LIMITED
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 1107 S MANNHEIM RD SUITE 212
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City | WESTCHESTER
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State | IL
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Zip | 60154-2561
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Country | US
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Telephone | 708-343-4704
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Fax | 708-343-4941
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Provider Business Mailing Address
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Address Line | 1107 S MANNHEIM RD SUITE 212
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City | WESTCHESTER
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State | IL
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Zip | 60154-2561
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Country | US
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Telephone | 708-343-4704
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Fax | 708-343-4941
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. SUNDAY NWANKPA
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Credential |
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Telephone | 708-343-4704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 203.000988
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License Number State | IL
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