Healthcare Provider Details

I. General information

NPI: 1699043349
Provider Name (Legal Business Name): STAR LIGHTS HOME HEALTH CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5765 N LINCOLN AVE SUITE 14
CHICAGO IL
60659-4720
US

IV. Provider business mailing address

5765 N LINCOLN AVE SUITE 14
CHICAGO IL
60659-4720
US

V. Phone/Fax

Practice location:
  • Phone: 773-506-7110
  • Fax: 773-506-4088
Mailing address:
  • Phone: 773-506-7110
  • Fax: 773-506-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number041268143
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number041268143
License Number StateIL

VIII. Authorized Official

Name: MS. RITA NKECHI OLUMBA I
Title or Position: DON
Credential: R.N
Phone: 773-506-7110