Organization
MEDDOC 40 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONESIA ROUSE MHA FACHE (OWNER)
(708) 567-1971
Entity
Organization
Contact information
Practice address
5113 S HARPER AVE, CHICAGO, IL 60615-4119
(708) 567-1071
Mailing address
2761 W 86TH ST, CHICAGO, IL 60652-3933
(773) 937-1992
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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