Healthcare Provider Details

I. General information

NPI: 1366799629
Provider Name (Legal Business Name): FAMILY HOME SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W HURON ST STE 2
CHICAGO IL
60642-8025
US

IV. Provider business mailing address

1040 W HURON ST STE 2
CHICAGO IL
60642-8025
US

V. Phone/Fax

Practice location:
  • Phone: 312-455-1949
  • Fax: 312-455-1415
Mailing address:
  • Phone: 312-455-1949
  • Fax: 312-455-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. MARSHA HOLMES
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 312-455-1949