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General NPI Number Information
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NPI Number | 1285333039
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Entity Type | Organization
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Legal Business Name | VANDERBILT HOME CARE CORP
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 1807 N HARLEM AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3716
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Country | US
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Telephone | 708-477-3033
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Fax |
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Provider Business Mailing Address
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Address Line | 839 S RIDGELAND AVE
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City | OAK PARK
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State | IL
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Zip | 60304-1434
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Country | US
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Telephone | 773-746-7087
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ DIRECTOR OF OPERATIONS
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Name | JACQUELINE VANDERBILT
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Credential |
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Telephone | 708-477-3033
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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 |
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License Number State |
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