Provider Demographics
NPI:1275816795
Name:DOMINION LIVING ASSISTANCE SERVICES INC
Entity Type:Organization
Organization Name:DOMINION LIVING ASSISTANCE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-226-1825
Mailing Address - Street 1:2 RED BUD CT
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-6516
Mailing Address - Country:US
Mailing Address - Phone:630-226-1825
Mailing Address - Fax:
Practice Address - Street 1:2 RED BUD CT
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-6516
Practice Address - Country:US
Practice Address - Phone:630-226-1825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health