Provider Demographics
NPI:1386035889
Name:PRINCE&PRINCESS
Entity Type:Organization
Organization Name:PRINCE&PRINCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIMAT
Authorized Official - Middle Name:NIKE
Authorized Official - Last Name:AKOREDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-374-1159
Mailing Address - Street 1:3630 214TH PL
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2704
Mailing Address - Country:US
Mailing Address - Phone:708-374-1159
Mailing Address - Fax:
Practice Address - Street 1:3630 214TH PL
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2704
Practice Address - Country:US
Practice Address - Phone:708-374-1159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041402048261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy