MEDICARE: WHOLISTIC HOME HEALTH CARE LLC

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	:	1134764137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	6854 S PERRY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-3799
Country	:	US
Telephone Number	:	773-952-6194
Fax Number	:	773-952-7796

Provider Business Practice Location Address
First Line	:	6854 S PERRY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-3799
Country	:	US
Telephone Number	:	773-952-6194
Fax Number	:	773-952-7796

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ANGELINA GAUNA
Credential	:
Telephone Number	:	773-952-6194

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	11/13/2019

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