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General NPI Number Information
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NPI Number | 1972235554
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Entity Type | Organization
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Legal Business Name | ESSENTIAL HEALTH SUPPORT
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 1750 E 87TH ST STE 101
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City | CHICAGO
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State | IL
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Zip | 60617-2706
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Country | US
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Telephone | 872-444-3420
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Fax | 630-566-3467
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Provider Business Mailing Address
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Address Line | 8833 S CRANDON AVE
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City | CHICAGO
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State | IL
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Zip | 60617-3051
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Country | US
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Telephone | 312-590-1975
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | NICOLE WILSON
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Credential | APRN
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Telephone | 872-444-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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