Ivory Waddell

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

D14138856 Issued in IL

Practice address

3220 Adams St
Bellwood, IL 60104-2232

Phone

(708) 544-5677

NPI assigned

Sep 30, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Change Homehealth

  • Home Health Agency
  • Bellwood, IL
  • NPI 1053703124
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538265600000",
    "number": "1801371471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 ADAMS ST",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "601042232",
            "telephone_number": "708-544-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 ADAMS ST",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "601042232",
            "telephone_number": "708-544-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "IVORY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-30",
        "last_updated": "2018-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "D14138856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Unity I Care Inc.
• Universal Transportation II
• Vasu Smiles PLLC
• Village of Bellwood
• Joseph J. Vitez
• Jermaine Walker
• Robert L Walker, HT
• Aunderia Denise Wallace
• Eunice Watson
• West Suburban Senior Services

• Home Health Agency in Bellwood, IL
• Providers in Bellwood, IL by specialty
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.