MEDICARE: ASTER HOME HEALTH SERVICE, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	IL	PENDING

General Provider Information

NPI Number	:	1770884819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTER HOME HEALTH SERVICE, LLC

Provider Business Mailing Address
First Line	:	3101 N CALIFORNIA AVE
Second Line	:	SUITE 1S
City	:	CHICAGO
State	:	IL
Zip	:	60618-7007
Country	:	US
Telephone Number	:	773-267-5500
Fax Number	:	773-267-5501

Provider Business Practice Location Address
First Line	:	3101 N CALIFORNIA AVE
Second Line	:	SUITE 1S
City	:	CHICAGO
State	:	IL
Zip	:	60618-7007
Country	:	US
Telephone Number	:	773-267-5500
Fax Number	:	773-267-5501

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MR. KHALED OWEIMRIN
Credential	:	RPT
Telephone Number	:	773-267-5500

Provider Enumeration Date	:	11/05/2010
Last Update Date	:	11/05/2010

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