Provider Demographics
NPI:1114696564
Name:UCCT CORP
Entity Type:Organization
Organization Name:UCCT CORP
Other - Org Name:UCCT CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUEJIOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:224-659-1993
Mailing Address - Street 1:269 NORWAY DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103
Mailing Address - Country:US
Mailing Address - Phone:224-659-1993
Mailing Address - Fax:847-893-6183
Practice Address - Street 1:269 NORWAY DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103
Practice Address - Country:US
Practice Address - Phone:224-659-1993
Practice Address - Fax:847-893-6183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1952883290Medicaid