Provider Demographics
NPI:1760017917
Name:EHRENBERG, VINCE JUDE (FOUNDER PERICHAIR LL)
Entity Type:Individual
Prefix:MR
First Name:VINCE
Middle Name:JUDE
Last Name:EHRENBERG
Suffix:
Gender:M
Credentials:FOUNDER PERICHAIR LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 N VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3918
Mailing Address - Country:US
Mailing Address - Phone:773-849-3886
Mailing Address - Fax:
Practice Address - Street 1:5536 N VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3918
Practice Address - Country:US
Practice Address - Phone:773-849-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL352671922163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty