MEDICARE: AGAPE HOME HEALTH OF ILLINOIS, INC.

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		IL

General Provider Information

NPI Number	:	1013276583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE HOME HEALTH OF ILLINOIS, INC.

Provider Business Mailing Address
First Line	:	400 TWIN CREEKS DRIVE
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60640-1078
Country	:	US
Telephone Number	:	630-985-0550
Fax Number	:	630-985-0660

Provider Business Practice Location Address
First Line	:	400 TWIN CREEKS DRIVE
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60640-1040
Country	:	US
Telephone Number	:	630-985-0550
Fax Number	:	630-985-0660

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ILUMINADA L PEREZ
Credential	:	RN
Telephone Number	:	312-203-5235

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	05/03/2012

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