Healthcare Provider Details

I. General information

NPI: 1851056857
Provider Name (Legal Business Name): MERRY FAMILY HOME HEALTCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W DEVON AVE STE 300
CHICAGO IL
60659-1299
US

IV. Provider business mailing address

3601 W DEVON AVE STE 300
CHICAGO IL
60659-1299
US

V. Phone/Fax

Practice location:
  • Phone: 773-240-9225
  • Fax:
Mailing address:
  • Phone: 773-240-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS AGBONIFO
Title or Position: PRESIDENT
Credential:
Phone: 773-240-9225