Individual
CHARMAINE LEIGH RAMOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4735 WILLOW SPRINGS RD, LA GRANGE, IL 60525-6130
(708) 352-5259
Mailing address
4735 WILLOW SPRINGS RD, LA GRANGE, IL 60525-6130
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
057.003634
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057.003634
COTA CERTIFICATION
IL
Enumeration date
01/15/2016
Last updated
01/15/2016
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