MEDICARE: NEW HEAVENS 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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1912749748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HEAVENS CARE LLC

Provider Business Mailing Address
First Line	:	1341 N LONG AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-1306
Country	:	US
Telephone Number	:	773-938-3040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 N LONG AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-1306
Country	:	US
Telephone Number	:	224-300-6942
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CHRISTOPHER OSUJI
Credential	:
Telephone Number	:	773-977-6967

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	09/12/2024

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Directions to “NEW HEAVENS CARE LLC ” Practice Location

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