Healthcare Provider Details

I. General information

NPI: 1508805938
Provider Name (Legal Business Name): COMPREHENSIVE QUALITY CARE INC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 S KING DR
CHICAGO IL
60653-3395
US

IV. Provider business mailing address

3517 SOUTH MARTIN LUTHER KING DR.
CHICAGO IL
60653
UM

V. Phone/Fax

Practice location:
  • Phone: 773-924-5900
  • Fax: 773-924-5933
Mailing address:
  • Phone: 773-924-5900
  • Fax: 773-924-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010238
License Number StateIL

VIII. Authorized Official

Name: DR. JOHN M TAR
Title or Position: PRESIDENT &CEO
Credential: PHD
Phone: 773-924-5900