Blackbag Home Physician Service LLC
NPI #1770824161 in Park Forest, Illinois
Provider Information
- NPI Number
- 1770824161
- Entity Type
- Organization
- Organization Name
- Blackbag Home Physician Service LLC
- Primary Specialty
- Clinic/Center - Health Service
- Enumeration Date
- Mar 9, 2013
- Last Updated
- Dec 21, 2014
Practice Location
- Address
- 437 NAVAJO ST
- City
- Park Forest
- State
- Illinois
- ZIP Code
- 60466-2520
- Phone
- (815) 406-5011
Authorized Official
- Name
- NICHELLE HAMPTON
- Title
- CHIEF EXECUTIVE OFFICER
- Phone
- (312) 399-0285
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Health Service — Health Service |
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