Provider Demographics
NPI: | 1245362623 |
---|---|
Name: | CHUNJI-ONE, CORPORATION |
Entity type: | Organization |
Organization Name: | CHUNJI-ONE, CORPORATION |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | RN/OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SOLVITA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TAMOSIUNIENE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN/OWNER |
Authorized Official - Phone: | 847-376-8939 |
Mailing Address - Street 1: | 1460 RENAISSANCE DRIVE |
Mailing Address - Street 2: | SUITE 411 |
Mailing Address - City: | PARK RIDGE |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60068 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 847-376-8939 |
Mailing Address - Fax: | 847-376-8936 |
Practice Address - Street 1: | 1460 RENAISSANCE DRIVE |
Practice Address - Street 2: | SUITE 411 |
Practice Address - City: | PARK RIDGE |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60068 |
Practice Address - Country: | US |
Practice Address - Phone: | 847-376-8939 |
Practice Address - Fax: | 847-376-8936 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-12 |
Last Update Date: | 2015-10-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
251E00000X | ||
IL | HI108326 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |