Provider Demographics
NPI:1871350280
Name:LARRYG HEALTHCARE SERVICES
Entity type:Organization
Organization Name:LARRYG HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLANREWAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-943-2814
Mailing Address - Street 1:3545 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2360
Mailing Address - Country:US
Mailing Address - Phone:773-943-2814
Mailing Address - Fax:
Practice Address - Street 1:3545 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2360
Practice Address - Country:US
Practice Address - Phone:773-943-2814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care