MEDICARE: HENRY BOOTH HOUSE

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1134654890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY BOOTH HOUSE

Provider Business Mailing Address
First Line	:	2907 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3389
Country	:	US
Telephone Number	:	312-949-3600
Fax Number	:	312-225-6324

Provider Business Practice Location Address
First Line	:	2907 S. WABASH
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616
Country	:	US
Telephone Number	:	312-949-3600
Fax Number	:	312-225-6324

Authorized Official
Title or Position	:	CEO
Name	:	SCOTT PERKINS
Credential	:
Telephone Number	:	312-949-3609

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	05/01/2017

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Directions to “HENRY BOOTH HOUSE ” Practice Location

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