MEDICARE: UNIVERSUM 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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1083213813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSUM CARE LLC

Provider Business Mailing Address
First Line	:	4652 N ORANGE AVE
Second Line	:
City	:	NORRIDGE
State	:	IL
Zip	:	60706-4408
Country	:	US
Telephone Number	:	773-807-9450
Fax Number	:

Provider Business Practice Location Address
First Line	:	4652 N ORANGE AVE
Second Line	:
City	:	NORRIDGE
State	:	IL
Zip	:	60706-4408
Country	:	US
Telephone Number	:	773-807-9450
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RASHID ISMAILOV
Credential	:
Telephone Number	:	773-807-9450

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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