MEDICARE: LEGEND HOME HEALTH 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	:	1285803486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGEND HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	3405 W FULLERTON AVE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60647-2415
Country	:	US
Telephone Number	:	773-278-0100
Fax Number	:	773-278-0111

Provider Business Practice Location Address
First Line	:	3405 W FULLERTON AVE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60647-2415
Country	:	US
Telephone Number	:	773-278-0100
Fax Number	:	773-278-0111

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MARY JANE FLOJO
Credential	:
Telephone Number	:	773-278-0100

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	10/25/2011

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