Provider Demographics
NPI:1124513130
Name:RIOS, LUCILIA
Entity type:Individual
Prefix:
First Name:LUCILIA
Middle Name:
Last Name:RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3315
Mailing Address - Country:US
Mailing Address - Phone:847-599-8181
Mailing Address - Fax:847-672-8943
Practice Address - Street 1:2424 GRAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3315
Practice Address - Country:US
Practice Address - Phone:847-599-8181
Practice Address - Fax:847-672-8943
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1124513130OtherSELF PAID