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NPI Code Detail

MEDICARE: WILLIS HEALTH AGENCY INC.

MEDICARE: WILLIS HEALTH AGENCY INC.
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 : 1619612165
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLIS HEALTH AGENCY INC.
Provider Business Mailing Address
First Line : 1448 N MILWAUKEE AVE STE 202
Second Line :
City : CHICAGO
State : IL
Zip : 60622-6412
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1448 N MILWAUKEE AVE STE 202
Second Line :
City : CHICAGO
State : IL
Zip : 60622-6412
Country : US
Telephone Number : 708-462-4288
Fax Number :
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : STEPHANIE WILLIS
Credential :
Telephone Number : 312-480-1656
Provider Enumeration Date : 04/29/2022
Last Update Date : 04/29/2022

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