MEDICARE: HEXAGRAM 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	1010712	IL

General Provider Information

NPI Number	:	1275738502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEXAGRAM HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	4747 W PETERSON AVE
Second Line	:	410
City	:	CHICAGO
State	:	IL
Zip	:	60646-5712
Country	:	US
Telephone Number	:	773-205-1416
Fax Number	:	773-557-7048

Provider Business Practice Location Address
First Line	:	4747 W PETERSON AVE
Second Line	:	410
City	:	CHICAGO
State	:	IL
Zip	:	60646-5712
Country	:	US
Telephone Number	:	773-205-1416
Fax Number	:	773-557-7048

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JACQUELINE EMBRADURA TUANQUI
Credential	:
Telephone Number	:	773-205-1416

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	12/28/2011

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