=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083837322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APEX LICENSED HOMEHEALT CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1525 E 53RD ST SUITE 806
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60615-4557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-291-0756
-----------------------------------------------------
Fax | 773-684-2671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1525 E 53RD ST SUITE 806
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60615-4557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-291-0756
-----------------------------------------------------
Fax | 773-684-2671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DIANNE GLENN
-----------------------------------------------------
Credential | RNC, MESAII, CADC, M
-----------------------------------------------------
Telephone | 312-291-0756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------