Healthcare Provider Details

I. General information

NPI: 1033115571
Provider Name (Legal Business Name): CENTRAL HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 N CENTRAL AVE
CHICAGO IL
60639-1316
US

IV. Provider business mailing address

2450 N CENTRAL AVE
CHICAGO IL
60639-1316
US

V. Phone/Fax

Practice location:
  • Phone: 773-889-1333
  • Fax: 773-889-1516
Mailing address:
  • Phone: 773-889-1333
  • Fax: 773-889-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000019364
License Number StateIL

VIII. Authorized Official

Name: DAVID LUBOWSKY
Title or Position: BOOKKEEPER
Credential:
Phone: 847-679-7484