=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467925339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 21 CENTURY HOME CARE,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 E NORTHWEST HWY STE 717
-----------------------------------------------------
City | PALATINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60074-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-330-2323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4939 LICHFIELD DR
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60010-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-758-1314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. MARIA KOBYLIANSKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-758-1314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------