MEDICARE: HAVE A HEART HOMEMAKER SERVICES, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		IL

General Provider Information

NPI Number	:	1013255900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVE A HEART HOMEMAKER SERVICES, LTD

Provider Business Mailing Address
First Line	:	1523 OTTO BLVD
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3442
Country	:	US
Telephone Number	:	708-756-2500
Fax Number	:	708-756-2501

Provider Business Practice Location Address
First Line	:	1523 OTTO BLVD
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3442
Country	:	US
Telephone Number	:	708-756-2500
Fax Number	:	708-756-2501

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS SHIRLEY BROCKINGTON
Credential	:	AA
Telephone Number	:	708-756-2500

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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