MEDICARE: VANDERBILT HOME CARE CORP

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

General Provider Information

NPI Number	:	1285333039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDERBILT HOME CARE CORP

Provider Business Mailing Address
First Line	:	839 S RIDGELAND AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-1434
Country	:	US
Telephone Number	:	773-746-7087
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-3716
Country	:	US
Telephone Number	:	708-477-3033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ DIRECTOR OF OPERATIONS
Name	:	JACQUELINE VANDERBILT
Credential	:
Telephone Number	:	708-477-3033

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	03/01/2023

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