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General NPI Number Information
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NPI Number | 1871755405
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Entity Type | Organization
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Legal Business Name | MIDWEST HEALTHCARE PROVIDERS, INC.
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 5360 FARGO AVE
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City | SKOKIE
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State | IL
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Zip | 60077-3250
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Country | US
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Telephone | 847-679-4387
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Fax | 847-679-4437
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Provider Business Mailing Address
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Address Line | 5360 FARGO AVE STE 201
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City | SKOKIE
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State | IL
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Zip | 60077-3250
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Country | US
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Telephone | 847-679-4387
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Fax | 847-679-4437
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Authorized Official
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Title or Position | OWNER/AGENCY SUPERVISOR
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Name | MS. DAWN WAGNER
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Credential | MSN, RN
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Telephone | 847-679-4387
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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 | 1010927
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License Number State | IL
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