MEDICARE: HOMECARE AND HAIR 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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1295465060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMECARE AND HAIR LLC

Provider Business Mailing Address
First Line	:	PO BOX 607004
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-0961
Country	:	US
Telephone Number	:	773-640-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	3432 W DIVERSEY AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1221
Country	:	US
Telephone Number	:	312-777-9105
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL ASSISTANT
Name	:	CLESHAWN HENRY
Credential	:	CMAA
Telephone Number	:	312-777-9105

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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Directions to “HOMECARE AND HAIR LLC ” Practice Location

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