Healthcare Provider Details

I. General information

NPI: 1922191105
Provider Name (Legal Business Name): SAMLAND HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 W MONTROSE AVE SUITE G
CHICAGO IL
60641-2016
US

IV. Provider business mailing address

4320 W MONTROSE AVE SUITE G
CHICAGO IL
60641-2016
US

V. Phone/Fax

Practice location:
  • Phone: 773-202-4720
  • Fax: 773-202-4725
Mailing address:
  • Phone: 773-202-4720
  • Fax: 773-202-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number001010361
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number001010361
License Number StateIL

VIII. Authorized Official

Name: MS. FLORA L. SAMPANG
Title or Position: PRESIDENT
Credential:
Phone: 773-202-4720