MEDICARE: EXTENDED HOME LIVING 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	332BC3200X	Customized Equipment (DME)		IL
2	332B00000X	Durable Medical Equipment & Medical Supplies		IL

General Provider Information

NPI Number	:	1477725620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXTENDED HOME LIVING SERVICES, INC.

Provider Business Mailing Address
First Line	:	210 W CAMPUS DR STE B
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-7829
Country	:	US
Telephone Number	:	847-215-9490
Fax Number	:	847-590-1728

Provider Business Practice Location Address
First Line	:	210 W CAMPUS DR STE B
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-7829
Country	:	US
Telephone Number	:	847-215-9490
Fax Number	:	847-590-1728

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH CRANDALL
Credential	:
Telephone Number	:	847-215-9490

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	07/21/2022

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