Dubois-Douglas, Inc.

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

12HM519014 Issued in IL

Legal business name

DUBOIS-DOUGLAS, INC.

Practice address

1016 W Jackson Blvd
Chicago, IL 60607-2914

Phone

(312) 288-8640

Fax

(312) 243-1516

NPI assigned

Jul 25, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Funmi Martins-Mensah

Title

Executive Director

Phone

(815) 295-3146

Specialties & licenses 4

Addresses

Other identifiers 4

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

{
    "created_epoch": "1374710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1982046355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 W JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072914",
            "telephone_number": "312-288-8640",
            "fax_number": "312-243-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 W JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072914",
            "telephone_number": "312-288-8640",
            "fax_number": "312-243-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBOIS-DOUGLAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-25",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "MARTINS-MENSAH",
        "authorized_official_first_name": "FUNMI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-295-3146",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "IL",
            "license": "12HM519014",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "IL",
            "license": "QMXHPQ0915",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "IL",
            "license": "44CSA00737",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "IL",
            "license": "QXIPQ0000096439",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0802",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0301",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0302",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justyne Dominique Cherisse Duberry, M.D.
• Sagel Kiran Dubey, MD
• Tehilla Dubin, LSW
• Yana Dubinsky, PSY.D.
• Gabrielle Bryn Duboff, BSN RN, PMH-BC, CPN
• Alton Clark Dubois, PH.D.
• Chris Dubois
• Mary Elizabeth Dubon, MD
• Caroline Haughey Dubord, APRN
• James Todd Dubose, PH.D.

• In Home Supportive Care Agency in Chicago, IL
• Providers in Chicago, IL by specialty
• In Home Supportive Care Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.