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General NPI Number Information
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NPI Number | 1093877656
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Entity Type | Organization
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Legal Business Name | SUBURBAN HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 9318 S KEDZIE AVE SUITE 8
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2323
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Country | US
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Telephone | 708-907-3912
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Fax | 708-907-3915
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Provider Business Mailing Address
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Address Line | 9318 S KEDZIE AVE SUITE 8
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2323
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Country | US
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Telephone | 708-907-3912
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Fax | 708-907-3915
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Authorized Official
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Title or Position | PRESIDENT
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Name | ASHRAF ALI ELKOSSEI
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Credential | P.T.
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Telephone | 708-907-3912
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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 | 1011617
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License Number State | IL
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