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NPI Code Detail

MEDICARE: WONDER CARE HOME CARE LLC

MEDICARE: WONDER CARE HOME CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1013528454
Entity Type Code : Organization
Provider Name (Legal Business Name) : WONDER CARE HOME CARE LLC
Provider Business Mailing Address
First Line : 1903 EUCLID AVE APT B2
Second Line :
City : BERWYN
State : IL
Zip : 60402-1862
Country : US
Telephone Number : 708-657-0987
Fax Number :
Provider Business Practice Location Address
First Line : 1903 EUCLID AVE APT B2
Second Line :
City : BERWYN
State : IL
Zip : 60402-1862
Country : US
Telephone Number : 708-657-0987
Fax Number :
Authorized Official
Title or Position : OWNER/CEO
Name : JOVON JOHNSON
Credential :
Telephone Number : 708-657-0987
Provider Enumeration Date : 08/10/2020
Last Update Date : 08/10/2020

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Directions to “WONDER CARE HOME CARE LLC ” Practice Location

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