Provider Demographics
NPI:1780844910
Name:CROWN MEDICARE INC.
Entity Type:Organization
Organization Name:CROWN MEDICARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEREMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OTESILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-338-3305
Mailing Address - Street 1:2243 S 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-3820
Mailing Address - Country:US
Mailing Address - Phone:708-338-3305
Mailing Address - Fax:708-338-3306
Practice Address - Street 1:2243 S 24TH AVE
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155-3820
Practice Address - Country:US
Practice Address - Phone:708-338-3305
Practice Address - Fax:708-338-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)