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General NPI Number Information
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NPI Number | 1275907990
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Entity Type | Organization
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Legal Business Name | LIFECARE@HOME
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 5550 S SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60637-5051
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Country | US
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Telephone | 773-358-7438
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Fax | 773-752-0056
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Provider Business Mailing Address
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Address Line | 5550 S SHORE DR
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City | CHICAGO
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State | IL
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Zip | 60637-5051
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Country | US
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Telephone | 773-358-7438
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Fax | 773-752-0056
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BOBBY POPE
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Credential |
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Telephone | 774-447-3601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3000305
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 3000305
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License Number State | IL
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