MEDICARE: CORALHEARTS HOME HEALTH CARE

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1174105308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORALHEARTS HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	6110 N KENMORE AVE APT 410
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2740
Country	:	US
Telephone Number	:	773-961-8885
Fax Number	:	773-961-8885

Provider Business Practice Location Address
First Line	:	6110 N KENMORE AVE APT 410
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2740
Country	:	US
Telephone Number	:	773-961-8885
Fax Number	:	773-961-8885

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	OLABISI APINKE EZEKIEL
Credential	:	RN
Telephone Number	:	708-300-4938

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	04/27/2021

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