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General NPI Number Information
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NPI Number | 1275320723
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Entity Type | Organization
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Legal Business Name | ITARA42 HOME CARE AGENCY
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 12051 S YALE AVE
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City | CHICAGO
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State | IL
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Zip | 60628-6536
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Country | US
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Telephone | 773-840-3729
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Fax |
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Provider Business Mailing Address
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Address Line | 25 E 16TH ST
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3410
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Country | US
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Telephone | 773-999-5051
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DON DAVIS
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Credential |
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Telephone | 773-999-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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