Provider Demographics
NPI:1659130144
Name:SOULFULSPACE HOME HEALTH INC
Entity Type:Organization
Organization Name:SOULFULSPACE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESSIE
Authorized Official - Middle Name:REE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-306-6020
Mailing Address - Street 1:8745 W HIGGINS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2753
Mailing Address - Country:US
Mailing Address - Phone:847-306-6020
Mailing Address - Fax:
Practice Address - Street 1:8745 W HIGGINS RD STE 110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2753
Practice Address - Country:US
Practice Address - Phone:847-306-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health