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General NPI Number Information
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NPI Number | 1821763947
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Entity Type | Organization
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Legal Business Name | CONRAD CARE INCORPORATED
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 3525 W PETERSON AVE STE 505
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City | CHICAGO
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State | IL
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Zip | 60659-3317
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Country | US
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Telephone | 773-240-9225
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Fax |
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Provider Business Mailing Address
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Address Line | 23 STIRLING LN APT 1822
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City | WILLOWBROOK
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State | IL
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Zip | 60527-3181
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Country | US
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Telephone | 773-240-9225
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NICHOLAS AGBONIFO
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Credential |
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Telephone | 773-240-9225
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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