Provider Demographics
NPI:1174105308
Name:CORALHEARTS HOME HEALTH CARE
Entity type:Organization
Organization Name:CORALHEARTS HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLABISI
Authorized Official - Middle Name:APINKE
Authorized Official - Last Name:EZEKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-300-4938
Mailing Address - Street 1:6110 N KENMORE AVE APT 410
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2740
Mailing Address - Country:US
Mailing Address - Phone:773-961-8885
Mailing Address - Fax:773-961-8885
Practice Address - Street 1:6110 N KENMORE AVE APT 410
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2740
Practice Address - Country:US
Practice Address - Phone:773-961-8885
Practice Address - Fax:773-961-8885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE TRAO GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care