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General NPI Number Information
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NPI Number | 1871521526
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Entity Type | Organization
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Legal Business Name | MID-CARE, INC.
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 4006 W ADDISON ST
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City | CHICAGO
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State | IL
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Zip | 60641-3905
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Country | US
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Telephone | 773-202-0195
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Fax | 773-202-0197
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Provider Business Mailing Address
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Address Line | 4006 W ADDISON ST
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City | CHICAGO
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State | IL
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Zip | 60641-3905
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Country | US
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Telephone | 773-202-0195
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Fax | 773-202-0197
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MRS. MYRNA A. CORDERO
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Credential | R.N.
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Telephone | 773-202-0195
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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 | 1010552
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License Number State | IL
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