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General NPI Number Information
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NPI Number | 1275744914
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Entity Type | Organization
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Legal Business Name | MCJ HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 6120 W NORTH AVE STE 105
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City | CHICAGO
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State | IL
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Zip | 60639-3903
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Country | US
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Telephone | 773-550-9867
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Fax |
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Provider Business Mailing Address
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Address Line | 6120 W NORTH AVE STE 105
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City | CHICAGO
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State | IL
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Zip | 60639-3903
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Country | US
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Telephone | 773-550-9867
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MANUEL C COMISO JR.
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Credential | RN
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Telephone | 773-550-9867
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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 | 65051125
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License Number State | IL
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