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General NPI Number Information
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NPI Number | 1427836410
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Entity Type | Organization
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Legal Business Name | OUR COMMUNITY HOME CARE
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 635 W. 73
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City | CHICAGO
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State | IL
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Zip | 60621
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Country | US
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Telephone | 216-906-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 STRATHAVON RD UPPR
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-5228
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Country | US
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Telephone | 216-906-5610
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHAUN'DREA CLARK
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Credential |
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Telephone | 216-906-5610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 251E00000X
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Taxonomy Name | Home Health 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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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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 | 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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