MEDICARE: URHAI COMMUNITY SERVICE CENTER

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1306030556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URHAI COMMUNITY SERVICE CENTER

Provider Business Mailing Address
First Line	:	2945 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3811
Country	:	US
Telephone Number	:	773-275-2688
Fax Number	:	773-275-2599

Provider Business Practice Location Address
First Line	:	2945 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3811
Country	:	US
Telephone Number	:	773-275-2688
Fax Number	:	773-275-2599

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS ANGEL KINDO
Credential	:	N/A
Telephone Number	:	773-275-2688

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	06/21/2016

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