Provider Demographics
NPI:1457984411
Name:DERON LOGICARE LLC
Entity type:Organization
Organization Name:DERON LOGICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADERONKE
Authorized Official - Middle Name:O
Authorized Official - Last Name:FALADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:872-806-9627
Mailing Address - Street 1:9126 N LINCOLN DR APT 2D
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4947
Mailing Address - Country:US
Mailing Address - Phone:872-806-9627
Mailing Address - Fax:
Practice Address - Street 1:9126 N LINCOLN DR APT 2D
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4947
Practice Address - Country:US
Practice Address - Phone:872-806-9627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)