=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568706042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NO PLACE LIKE HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2012
-----------------------------------------------------
Last Update Date | 11/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1835 W ERIE ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-5520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-647-0007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 429 W OHIO ST SUITE 152
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-647-0007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | MR. RAVI CHADHA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 563-940-0162
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 3000733
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------