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General NPI Number Information
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NPI Number | 1689625857
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Entity Type | Organization
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Legal Business Name | FORUM HEALTH CARE INC
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 900 SKOKIE BLVD SUITE 230
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City | NORTHBROOK
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State | IL
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Zip | 60062-4012
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Country | US
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Telephone | 847-897-9090
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Fax | 847-897-9090
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Provider Business Mailing Address
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Address Line | 900 SKOKIE BLVD SUITE 230
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City | NORTHBROOK
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State | IL
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Zip | 60062-4012
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Country | US
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Telephone | 847-897-9090
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Fax | 847-897-9090
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MRS. JULIA KHOMUTOV
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Credential | RN
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Telephone | 847-897-9090
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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 | 1010521
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License Number State | IL
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