=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902094063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RW NURSESTAFFERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2007
-----------------------------------------------------
Last Update Date | 10/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9449 S KEDZIE AVE
-----------------------------------------------------
City | EVERGREEN PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60805-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-386-3439
-----------------------------------------------------
Fax | 773-913-2765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3439 W 82ND PL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60652-2503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-386-3439
-----------------------------------------------------
Fax | 773-913-2765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED NURSE
-----------------------------------------------------
Name | TIRANEY REDMOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-306-2547
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2007-N1041
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------