Healthcare Provider Details

I. General information

NPI: 1871873463
Provider Name (Legal Business Name): FRIENDS AND FAMILY HOME HEALTHCARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17831 YALE LN
COUNTRY CLUB HILLS IL
60478-4951
US

IV. Provider business mailing address

17831 YALE LN
COUNTRY CLUB HILLS IL
60478-4951
US

V. Phone/Fax

Practice location:
  • Phone: 708-262-0959
  • Fax:
Mailing address:
  • Phone: 708-262-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number02779196
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number02779196
License Number StateIL

VIII. Authorized Official

Name: MRS. DOROTHY NEAL
Title or Position: CEO
Credential:
Phone: 708-262-0959