Provider Demographics
NPI:1528631561
Name:ANOVA HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:ANOVA HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SEUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLESI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:773-225-9417
Mailing Address - Street 1:1252 S FEDERAL ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-4901
Mailing Address - Country:US
Mailing Address - Phone:773-225-9417
Mailing Address - Fax:
Practice Address - Street 1:1134 E 152ND ST
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2884
Practice Address - Country:US
Practice Address - Phone:773-225-9417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities