Provider Demographics
NPI:1275994089
Name:BRILLIANT CHOICE
Entity Type:Organization
Organization Name:BRILLIANT CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ASIEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-292-6213
Mailing Address - Street 1:4142 S MICHIGAN AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-2259
Mailing Address - Country:US
Mailing Address - Phone:312-292-6213
Mailing Address - Fax:
Practice Address - Street 1:4142 S MICHIGAN AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-2259
Practice Address - Country:US
Practice Address - Phone:312-292-6213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)