Healthcare Provider Details

I. General information

NPI: 1316334907
Provider Name (Legal Business Name): DEAN HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6604 N ASHLAND AVE 3 J
CHICAGO IL
60626-4151
US

IV. Provider business mailing address

6604 N ASHLAND AVE 3 J
CHICAGO IL
60626-4151
US

V. Phone/Fax

Practice location:
  • Phone: 773-754-5829
  • Fax: 773-856-0319
Mailing address:
  • Phone: 773-754-5829
  • Fax: 773-856-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number3001084
License Number StateIL

VIII. Authorized Official

Name: MS. SANDRA DEAN
Title or Position: OWNER
Credential:
Phone: 773-754-5829