MEDICARE: IMMANUEL HOME CARE SERVICES, INC.

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	251E00000X	Home Health Agency		IL

General Provider Information

NPI Number	:	1194948976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMANUEL HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	712 E 47TH ST
Second Line	:	SUITE 301E
City	:	CHICAGO
State	:	IL
Zip	:	60653-4202
Country	:	US
Telephone Number	:	773-285-2227
Fax Number	:	773-285-3033

Provider Business Practice Location Address
First Line	:	712 E 47TH ST
Second Line	:	SUITE 301E
City	:	CHICAGO
State	:	IL
Zip	:	60653-4202
Country	:	US
Telephone Number	:	773-285-2227
Fax Number	:	773-285-3033

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. IRENE EDWARDS EDWARDS
Credential	:	RN
Telephone Number	:	815-577-7192

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/12/2008

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