Healthcare Provider Details

I. General information

NPI: 1992145031
Provider Name (Legal Business Name): CHRIST MISSIONARY HOME HEALTH AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W 71ST ST APT 2FRONT
CHICAGO IL
60629-3003
US

IV. Provider business mailing address

PO BOX 368218
CHICAGO IL
60636-8218
US

V. Phone/Fax

Practice location:
  • Phone: 312-566-1888
  • Fax:
Mailing address:
  • Phone: 312-566-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PROF. MELLONY LASHON GANT
Title or Position: MANAGER / DIRECTOR/ PRESIDENT/
Credential: HOME CARE SERVICES
Phone: 312-566-1888