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General NPI Number Information
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NPI Number | 1790191906
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Entity Type | Organization
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Legal Business Name | EMPI CARE CENTER
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 616 W 123RD ST
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City | CHICAGO
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State | IL
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Zip | 60628-6408
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Country | US
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Telephone | 773-468-0765
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Fax | 773-468-0765
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Provider Business Mailing Address
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Address Line | 616 W 123RD ST
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City | CHICAGO
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State | IL
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Zip | 60628-6408
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Country | US
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Telephone | 773-468-0765
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Fax | 773-468-0765
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Authorized Official
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Title or Position | CEO
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Name | ABRAHAM ALLI-BROWN
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Credential |
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Telephone | 773-895-8970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | A2741KD1
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License Number State | IL
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