Healthcare Provider Details

I. General information

NPI: 1730952813
Provider Name (Legal Business Name): TBF HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 CRAWFORD AVE # L1
SKOKIE IL
60076-1700
US

IV. Provider business mailing address

9150 CRAWFORD AVE # L1
SKOKIE IL
60076-1700
US

V. Phone/Fax

Practice location:
  • Phone: 224-548-0927
  • Fax: 847-556-6544
Mailing address:
  • Phone: 224-548-0927
  • Fax: 847-556-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TAKALA FOMOND
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 224-420-6894