Provider Demographics
NPI:1104360700
Name:AIDPRO HEALTH PROVIDERS LLC
Entity Type:Organization
Organization Name:AIDPRO HEALTH PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RIZALDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-240-8088
Mailing Address - Street 1:16325 HARLEM AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2509
Mailing Address - Country:US
Mailing Address - Phone:708-240-8088
Mailing Address - Fax:708-251-1123
Practice Address - Street 1:16325 HARLEM AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2509
Practice Address - Country:US
Practice Address - Phone:708-240-8088
Practice Address - Fax:708-251-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000500251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care