Organization
1ST JUVENANT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HASSAN MATOVU (MANAGER)
(773) 249-4377
Entity
Organization
Contact information
Practice address
4320 WINFIELD RD STE 200, WARRENVILLE, IL 60555-4023
(773) 249-4377
(708) 377-6558
Mailing address
4320 WINFIELD RD STE 200, WARRENVILLE, IL 60555-4023
(773) 249-4377
(708) 377-6558
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041352225
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
07/16/2019
Last updated
07/16/2019
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