Organization
APHS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS WANDA LORINE TALLEY (OWNER)
(312) 731-1455
Entity
Organization
Contact information
Practice address
122 E 140CT., RIVERDALE, LA 60652
(312) 731-1455
(773) 924-8450
Mailing address
122 E 140CT., RIVERDALE, LA 60652
(312) 731-1455
(773) 924-8450
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1740333
IL
Other
Enumeration date
08/07/2006
Last updated
07/21/2022
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