Provider Demographics
NPI:1790419646
Name:GLOMAST HEALTH SERVICES
Entity Type:Organization
Organization Name:GLOMAST HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUMUYIDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-823-0886
Mailing Address - Street 1:4341 S DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-2910
Mailing Address - Country:US
Mailing Address - Phone:312-823-0886
Mailing Address - Fax:888-251-1030
Practice Address - Street 1:4341 S DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-2910
Practice Address - Country:US
Practice Address - Phone:312-823-0886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-14
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054065482162OtherDRIVER'S LICENSE