Basic Information
| Provider Information | |||||||||
| NPI: | 1104210533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARSON | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | DUPREE | ||||||||
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| Credential: | C.O.T.A./L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7653 S BISHOP ST APT 1S | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606204126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737236180 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3703 W LAKE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600261266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479981188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2015 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | 057.000457 | IL | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.