MEDICARE: REHOBOTH 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

General Provider Information

NPI Number	:	1316204233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHOBOTH HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	123 W WASHINGTON ST
Second Line	:	SUITE 325
City	:	OSWEGO
State	:	IL
Zip	:	60543-8214
Country	:	US
Telephone Number	:	815-577-3747
Fax Number	:	818-577-3748

Provider Business Practice Location Address
First Line	:	123 W WASHINGTON ST
Second Line	:	SUITE 325
City	:	OSWEGO
State	:	IL
Zip	:	60543-8214
Country	:	US
Telephone Number	:	815-577-3747
Fax Number	:	815-577-3748

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARIE SALAHOU
Credential	:
Telephone Number	:	630-863-9930

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	11/26/2014

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