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General NPI Number Information
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NPI Number | 1265742563
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Entity Type | Organization
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Legal Business Name | FAVOS HOME CARE INC.
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 5007 LINCOLN AVE SUITE 202
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City | LISLE
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State | IL
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Zip | 60532-4187
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Country | US
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Telephone | 630-434-9033
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Fax | 630-434-9035
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Provider Business Mailing Address
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Address Line | 5007 LINCOLN AVE SUITE 202
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City | LISLE
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State | IL
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Zip | 60532-4187
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Country | US
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Telephone | 630-434-9033
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Fax | 630-434-9035
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VICTORIA OLUFUNKE AKINYEMI
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Credential |
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Telephone | 630-434-9033
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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 | 3000160
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 4000308
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License Number State | IL
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