MEDICARE: GREAT PARAGON HEALTH CARE 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	1010583	IL

General Provider Information

NPI Number	:	1538170345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT PARAGON HEALTH CARE INC.

Provider Business Mailing Address
First Line	:	2640 W TOUHY AVE
Second Line	:	STE. 205-206
City	:	CHICAGO
State	:	IL
Zip	:	60645-3198
Country	:	US
Telephone Number	:	773-274-7694
Fax Number	:	773-274-9082

Provider Business Practice Location Address
First Line	:	2640 W TOUHY AVE
Second Line	:	STE. 205-206
City	:	CHICAGO
State	:	IL
Zip	:	60645-3198
Country	:	US
Telephone Number	:	773-274-7694
Fax Number	:	773-274-9082

Authorized Official
Title or Position	:	DIRECTOR/ADMINISTRATOR
Name	:	MRS. AIWUYO RITA OBASEKI
Credential	:	RN
Telephone Number	:	773-274-7694

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/21/2011

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