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Organization
PRESENCE PROVISO FAMILY SERVICES INC
Active
Organization
PRESENCE PROVISO FAMILY SERVICES INC
Active
Other names
Proviso Family Services Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELVONNE WICKLIFFE-JONES (CREDENTIALING MGR)
(630) 914-2417
Entity
Organization
Contact information
Practice address
2940 N ASHLAND AVE, CHICAGO, IL 60657-4004
(773) 525-4440
(773) 525-7771
Mailing address
1000 REMINGTON BOULEVARD, SUITE 100, BOLINGBROOK, IL 60440-0000
(630) 914-2417
(630) 914-2499
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
IL
Other
Enumeration date
09/12/2011
Last updated
04/09/2013
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