MEDICARE: MEDEX HOME HEALTHCARE INCORPORATED

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

General Provider Information

NPI Number	:	1922109966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEX HOME HEALTHCARE INCORPORATED

Provider Business Mailing Address
First Line	:	8124 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-5104
Country	:	US
Telephone Number	:	773-488-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	8124 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-5104
Country	:	US
Telephone Number	:	773-488-1400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ADMINISTRATOR
Name	:	NELSON KWASI HODOGBEY
Credential	:
Telephone Number	:	773-488-1400

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	04/16/2009

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Directions to “MEDEX HOME HEALTHCARE INCORPORATED ” Practice Location

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