MEDICARE: MEDSTAR HOME HEALTH SERVICES LTD.

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	:	1093958365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR HOME HEALTH SERVICES LTD.

Provider Business Mailing Address
First Line	:	1019 W FULTON MARKET
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60607-1222
Country	:	US
Telephone Number	:	312-226-2828
Fax Number	:	312-226-1222

Provider Business Practice Location Address
First Line	:	1019 W FULTON MARKET
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60607-1222
Country	:	US
Telephone Number	:	312-226-2828
Fax Number	:	312-226-1222

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. OBED PENA
Credential	:
Telephone Number	:	312-226-2828

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	10/06/2009

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Directions to “MEDSTAR HOME HEALTH SERVICES LTD. ” Practice Location

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