Healthcare Provider Details

I. General information

NPI: 1417397795
Provider Name (Legal Business Name): A SPECIAL FRIEND HOME HEALTHCARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 S BLUE ISLAND AVE 2ND FL
CHICAGO IL
60608-2133
US

IV. Provider business mailing address

1647 S BLUE ISLAND AVE 2ND FL
CHICAGO IL
60608-2133
US

V. Phone/Fax

Practice location:
  • Phone: 312-772-6469
  • Fax: 773-888-3091
Mailing address:
  • Phone: 312-772-6469
  • Fax: 773-888-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number041371679
License Number StateIL

VIII. Authorized Official

Name: CAROL ANN REED
Title or Position: CEO
Credential:
Phone: 312-772-6469