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General NPI Number Information
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NPI Number | 1982046355
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Entity Type | Organization
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Legal Business Name | DUBOIS-DOUGLAS, INC.
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 1016 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-2914
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Country | US
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Telephone | 312-288-8640
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Fax | 312-243-1516
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Provider Business Mailing Address
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Address Line | 1016 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-2914
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Country | US
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Telephone | 312-288-8640
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Fax | 312-243-1516
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. FUNMI MARTINS-MENSAH
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Credential |
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Telephone | 815-295-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 44CSA00737
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | QMXHPQ0915
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | QXIPQ0000096439
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License Number State | IL
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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 | 12HM519014
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License Number State | IL
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