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General NPI Number Information
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NPI Number | 1992416556
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Entity Type | Organization
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Legal Business Name | FRESH START HOME COMMUNITY DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 7003 S NORMAL BLVD APT 1
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City | CHICAGO
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State | IL
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Zip | 60621-3064
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Country | US
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Telephone | 312-632-0811
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Fax | 855-267-5262
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Provider Business Mailing Address
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Address Line | 5168 S MICHIGAN AVE UNIT 4N
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City | CHICAGO
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State | IL
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Zip | 60615-3313
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Country | US
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Telephone | 312-632-0811
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/EXECUTIVE DIRECTOR
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Name | MRS. VIANNA C. LITTLE
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Credential |
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Telephone | 312-632-0811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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