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General NPI Number Information
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NPI Number | 1487974903
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH ASSYLA HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 7409 CHESTNUT CT
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City | WOODRIDGE
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State | IL
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Zip | 60517-2247
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Country | US
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Telephone | 630-964-4460
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Fax | 630-964-4463
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Provider Business Mailing Address
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Address Line | 7409 CHESTNUT CT
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City | WOODRIDGE
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State | IL
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Zip | 60517-2247
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Country | US
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Telephone | 630-964-4460
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Fax | 630-964-4463
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CHRISTOPHER M PENDON
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Credential |
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Telephone | 630-217-4572
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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 | 1011207
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License Number State | IL
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