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General NPI Number Information
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NPI Number | 1528414299
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Entity Type | Organization
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Legal Business Name | HOME SWEET HOME CARE LLC
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 05/11/2016
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Provider Practice Location Address
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Address Line | 72 S LA GRANGE RD STE. 5
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City | LA GRANGE
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State | IL
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Zip | 60525-2475
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Country | US
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Telephone | 708-469-7117
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Fax |
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Provider Business Mailing Address
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Address Line | 72 S LA GRANGE RD STE. 5
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City | LA GRANGE
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State | IL
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Zip | 60525-2475
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Country | US
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Telephone | 708-469-7117
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Fax |
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Authorized Official
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Title or Position | MANAGER OF OPERATIONS
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Name | MS. BETH ANN KORDICK
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Credential | PH..D.
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Telephone | 708-469-7117
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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 | 3000130
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License Number State | IL
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