Healthcare Provider Details

I. General information

NPI: 1962642033
Provider Name (Legal Business Name): CIRCLE OF FRIENDS HOME HEALTH CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 W ODGEN AVE
LYONS IL
60534-1389
US

IV. Provider business mailing address

7848 W. OGDEN AVE-B EAST
LYONS IL
60534-1389
US

V. Phone/Fax

Practice location:
  • Phone: 708-442-4962
  • Fax: 708-442-4962
Mailing address:
  • Phone: 708-442-4962
  • Fax: 708-442-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAPPLIED FOR
License Number StateIL

VIII. Authorized Official

Name: MR. SUDHIR KUMAR
Title or Position: ADMINISTRATOR
Credential: OTR/L
Phone: 708-442-4962