Individual
EBONE PORCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1953 W MAYPOLE AVE, CHICAGO, IL 60612-2466
(773) 620-0434
Mailing address
1953 W MAYPOLE AVE, CHICAGO, IL 60612-2466
(773) 620-0434
Taxonomy
Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
347C00000X
Private Vehicle
—
—
347E00000X
Transportation Broker
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/29/2021
Last updated
10/05/2021
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