Provider Demographics
NPI:1245126598
Name:BOLDEN, DARRELL D SR (HOME CARE AID)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:D
Last Name:BOLDEN
Suffix:SR
Gender:M
Credentials:HOME CARE AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1997
Mailing Address - Country:US
Mailing Address - Phone:312-890-6789
Mailing Address - Fax:
Practice Address - Street 1:616 S 14TH AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1997
Practice Address - Country:US
Practice Address - Phone:312-890-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker