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NPI Code Detail

MEDICARE: CENTRAL HOME INC

MEDICARE: CENTRAL HOME 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
1314000000XSkilled Nursing Facility000019364IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11142OTHERILBLUECROSS BLUESHIELD

General Provider Information

NPI Number : 1033115571
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL HOME INC
Provider Business Mailing Address
First Line : 2450 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1316
Country : US
Telephone Number : 773-889-1333
Fax Number : 773-889-1516
Provider Business Practice Location Address
First Line : 2450 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1316
Country : US
Telephone Number : 773-889-1333
Fax Number : 773-889-1516
Authorized Official
Title or Position : BOOKKEEPER
Name : DAVID LUBOWSKY
Credential :
Telephone Number : 847-679-7484
Provider Enumeration Date : 06/21/2005
Last Update Date : 05/07/2008

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Directions to “CENTRAL HOME INC ” Practice Location

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