=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033445283
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NE HEALTHCARE SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2009
-----------------------------------------------------
Last Update Date | 08/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1029 N SACRAMENTO AVE 1ST FL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 777-329-2889
-----------------------------------------------------
Fax | 773-252-3060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1029 N SACRAMENTO AVE 1ST FL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 777-329-2889
-----------------------------------------------------
Fax | 773-252-3060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MONETTE T TAFALLA
-----------------------------------------------------
Credential | A.A., B.S.B.A
-----------------------------------------------------
Telephone | 773-292-8891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010718
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1011788
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------