=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982657292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HOME HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 08/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2171 W EXECUTIVE DR SUITE 450
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60101-5610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-317-3300
-----------------------------------------------------
Fax | 630-317-3310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2171 W EXECUTIVE DR SUITE 450
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60101-5610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-317-3300
-----------------------------------------------------
Fax | 630-317-3310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. DEB MUFFOLETTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-317-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315D00000X
-----------------------------------------------------
Taxonomy Name | Inpatient Hospice
-----------------------------------------------------
License Number | 2002442
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------