=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508805938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE QUALITY CARE INC FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 01/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3517 S KING DR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60653-3395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-924-5900
-----------------------------------------------------
Fax | 773-924-5933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3517 SOUTH MARTIN LUTHER KING DR.
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60653
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 773-924-5900
-----------------------------------------------------
Fax | 773-924-5933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT &CEO
-----------------------------------------------------
Name | DR. JOHN M TAR
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 773-924-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010238
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------