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General NPI Number Information
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NPI Number | 1942016092
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Entity Type | Organization
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Legal Business Name | MEDDOC 40 LLC
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 5113 S HARPER AVE
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City | CHICAGO
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State | IL
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Zip | 60615-4119
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Country | US
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Telephone | 708-567-1071
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Fax |
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Provider Business Mailing Address
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Address Line | 2761 W 86TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-3933
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Country | US
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Telephone | 773-937-1992
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TONESIA ROUSE
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Credential | MHA FACHE
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Telephone | 708-567-1971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 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 #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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