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General NPI Number Information
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NPI Number | 1053655357
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Entity Type | Organization
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Legal Business Name | MA-DEAR HOME SERVICES, INC.
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST SUITE#1000
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 312-480-8553
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Fax | 773-667-9186
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Provider Business Mailing Address
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Address Line | 1525 E 53RD ST SUITE#1000
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 312-480-8553
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Fax | 773-667-9186
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. RENEE' MORRISSETTE-THOMAS
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Credential |
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Telephone | 312-480-8553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3000215
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License Number State | IL
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