MEDICARE: CARECOLLABORATIVE HOME HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1003895459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARECOLLABORATIVE HOME HEALTH

Provider Business Mailing Address
First Line	:	431 E 31ST ST
Second Line	:	#215
City	:	CHICAGO
State	:	IL
Zip	:	60616-4051
Country	:	US
Telephone Number	:	312-949-1010
Fax Number	:	312-949-9195

Provider Business Practice Location Address
First Line	:	431 E 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4051
Country	:	US
Telephone Number	:	312-949-1010
Fax Number	:	312-949-9195

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	MR. DAHRNELL FITZPATRICK
Credential	:
Telephone Number	:	312-949-1010

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	08/22/2020

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