=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760651228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILL STAFF HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2008
-----------------------------------------------------
Last Update Date | 02/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 E ALGONQUIN RD STE 2B
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60005-5321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-265-6591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 E ALGONQUIN RD
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60005-5321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NASHAT ALI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 224-265-6591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010674
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------