Provider Demographics
NPI:1174014716
Name:ENTREPRENEUR ENTERPRIZEZ
Entity Type:Organization
Organization Name:ENTREPRENEUR ENTERPRIZEZ
Other - Org Name:ELDERLY LOVE HOME CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:SHAUNTELL
Authorized Official - Last Name:WHOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:COUNSELOR
Authorized Official - Phone:682-772-9133
Mailing Address - Street 1:3017 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1835
Mailing Address - Country:US
Mailing Address - Phone:682-772-9133
Mailing Address - Fax:
Practice Address - Street 1:3017 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1835
Practice Address - Country:US
Practice Address - Phone:682-772-9133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL785049101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty