Provider Demographics
NPI:1821763947
Name:CONRAD CARE INCORPORATED
Entity Type:Organization
Organization Name:CONRAD CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBONIFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-240-9225
Mailing Address - Street 1:23 STIRLING LN APT 1822
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-3181
Mailing Address - Country:US
Mailing Address - Phone:773-240-9225
Mailing Address - Fax:
Practice Address - Street 1:3525 W PETERSON AVE STE 505
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3317
Practice Address - Country:US
Practice Address - Phone:773-240-9225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No251E00000XAgenciesHome Health