Organization
PRO VITA HOME CARE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODEL BUGAYONG RN (ADMINISTRATOR)
(773) 275-2190
Entity
Organization
Contact information
Practice address
5875 N LINCOLN AVE, SUITE 224, CHICAGO, IL 60659-4668
(773) 275-2190
(773) 275-2195
Mailing address
5875 N LINCOLN AVE, SUITE 224, CHICAGO, IL 60659-4668
(773) 275-2190
(773) 275-2195
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010672
IL
Other
Enumeration date
01/23/2007
Last updated
07/18/2008
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