Healthcare Provider Details

I. General information

NPI: 1477725620
Provider Name (Legal Business Name): EXTENDED HOME LIVING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W CAMPUS DR STE B
ARLINGTON HEIGHTS IL
60004-7829
US

IV. Provider business mailing address

210 W CAMPUS DR STE B
ARLINGTON HEIGHTS IL
60004-7829
US

V. Phone/Fax

Practice location:
  • Phone: 847-215-9490
  • Fax: 847-590-1728
Mailing address:
  • Phone: 847-215-9490
  • Fax: 847-590-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateIL

VIII. Authorized Official

Name: ELIZABETH CRANDALL
Title or Position: PRESIDENT
Credential:
Phone: 847-215-9490