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General NPI Number Information
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NPI Number | 1649823873
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Entity Type | Organization
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Legal Business Name | MOMENTS AT HOME RESPITE CARE AND HOME SERVICES, LLC.
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 7207 S INDIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60619-1008
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Country | US
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Telephone | 773-320-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 7207 S INDIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60619-1008
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Country | US
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Telephone | 773-320-8440
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | MS. ROSE LOFTIN-JOHNSON
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Credential | RN
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Telephone | 847-497-0654
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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 |
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License Number State |
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