Provider Demographics
NPI:1982011102
Name:ABILITY PROSTHETIC AND ORTHOTIC CARE INC.
Entity Type:Organization
Organization Name:ABILITY PROSTHETIC AND ORTHOTIC CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST AND ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NACER
Authorized Official - Middle Name:
Authorized Official - Last Name:KHENOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-529-0753
Mailing Address - Street 1:4710 W 95TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2546
Mailing Address - Country:US
Mailing Address - Phone:708-529-0753
Mailing Address - Fax:
Practice Address - Street 1:4710 W 95TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2546
Practice Address - Country:US
Practice Address - Phone:708-529-0753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL211.000279335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier