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General NPI Number Information
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NPI Number | 1790949154
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Entity Type | Organization
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Legal Business Name | KELLY HOME HEALTHCARE, INC
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 3235 VOLLMER RD STE 107
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2069
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Country | US
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Telephone | 708-983-9903
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Fax | 708-960-0419
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Provider Business Mailing Address
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Address Line | 3235 VOLLMER RD STE 107
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2069
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Country | US
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Telephone | 708-983-9903
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Fax | 708-960-0419
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Authorized Official
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Title or Position | PRESIDENT
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Name | NNEKA EZURIKE-GREEN
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Credential |
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Telephone | 708-983-9903
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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 |
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License Number State | IL
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