Provider Demographics
NPI:1295093730
Name:OSAWEOLUWA SERVICE INCORPORATED
Entity type:Organization
Organization Name:OSAWEOLUWA SERVICE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDOIGIAWERIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:312-952-7795
Mailing Address - Street 1:917 W 18TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2304
Mailing Address - Country:US
Mailing Address - Phone:312-496-3214
Mailing Address - Fax:312-929-2837
Practice Address - Street 1:917 W 18TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2304
Practice Address - Country:US
Practice Address - Phone:312-496-3214
Practice Address - Fax:312-929-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011413251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health