1912929845 NPI number — ST THOMAS HEALTH CARE INC

Table of content: (NPI 1912929845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912929845 NPI number — ST THOMAS HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST THOMAS HEALTH CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WAILAI HOME HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912929845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4554 N BROADWAY ST STE 312
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60640-5621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-764-1381
Provider Business Mailing Address Fax Number:
773-764-4636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4554 N BROADWAY ST STE 312
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640-5621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-764-1381
Provider Business Practice Location Address Fax Number:
773-764-4636
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAKANG
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-895-2951

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)