| NPI | 1043961642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALESIA BOYD CARLOCK Director 773-313-9040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 261QP2400X Clinic/Center, Prison Health | |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2022-03-18 |