Provider Demographics
NPI:1366632689
Name:MYNA HEALTH SERVICES
Entity Type:Organization
Organization Name:MYNA HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KWASI
Authorized Official - Middle Name:BOASIAKO
Authorized Official - Last Name:ANTWI
Authorized Official - Suffix:
Authorized Official - Credentials:AASC ADV RESPIRATORY
Authorized Official - Phone:773-407-5010
Mailing Address - Street 1:1230 CLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4855
Mailing Address - Country:US
Mailing Address - Phone:773-407-5010
Mailing Address - Fax:815-372-0441
Practice Address - Street 1:1230 CLAIRE AVE
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4855
Practice Address - Country:US
Practice Address - Phone:773-407-5010
Practice Address - Fax:815-372-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies