MEDICARE: ABRIDGE HOME CARE SERVICES

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	148245	OTHER	IL	PTAN

General Provider Information

NPI Number	:	1023464328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABRIDGE HOME CARE SERVICES

Provider Business Mailing Address
First Line	:	4744 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4744 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5706
Country	:	US
Telephone Number	:	773-999-3999
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	FEROZ JALAL
Credential	:
Telephone Number	:	773-999-3999

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	05/05/2016

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