MEDICARE: CHRIST MISSIONARY HOME HEALTH AGENCY, 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1992145031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIST MISSIONARY HOME HEALTH AGENCY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 368218
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-8218
Country	:	US
Telephone Number	:	312-566-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3121 W 71ST ST APT 2FRONT
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-3003
Country	:	US
Telephone Number	:	312-566-1888
Fax Number	:

Authorized Official
Title or Position	:	MANAGER / DIRECTOR/ PRESIDENT/
Name	:	PROF. MELLONY LASHON GANT
Credential	:	HOME CARE SERVICES
Telephone Number	:	312-566-1888

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	06/20/2018

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