Provider Demographics
NPI:1497124911
Name:TYRAFRANKLIN FRANKLIN ACCOUNT
Entity Type:Organization
Organization Name:TYRAFRANKLIN FRANKLIN ACCOUNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:TYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:APN-BC
Authorized Official - Phone:708-774-6255
Mailing Address - Street 1:513 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1234
Mailing Address - Country:US
Mailing Address - Phone:708-774-6255
Mailing Address - Fax:
Practice Address - Street 1:2357 W CONGRESS PKWY
Practice Address - Street 2:UNIT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3685
Practice Address - Country:US
Practice Address - Phone:312-590-1601
Practice Address - Fax:312-224-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013093251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health