=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861758153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACHIEVE HOME HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2012
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10001 DERBY LN STE 6
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-3749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-865-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10001 DERBY LN STE 6
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-3749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-865-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSING
-----------------------------------------------------
Name | AIDA M. TACAN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 708-865-8555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------