| NPI | 1154901783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARYRSHA DAVIS Nurse Practitioner 312-636-3722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251E00000X Home Health |
| 253Z00000X In Home Supportive Care | |
| 261Q00000X Clinic/Center | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2022-04-07 |