=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922191105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMLAND HOME HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 05/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 W MONTROSE AVE SUITE G
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60641-2016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-202-4720
-----------------------------------------------------
Fax | 773-202-4725
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4320 W MONTROSE AVE SUITE G
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60641-2016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-202-4720
-----------------------------------------------------
Fax | 773-202-4725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. FLORA L. SAMPANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-202-4720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 001010361
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 001010361
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------