MEDICARE: DEAN HOMECARE 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	311ZA0620X	Adult Care Home Facility	3001084	IL

General Provider Information

NPI Number	:	1316334907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEAN HOMECARE LLC

Provider Business Mailing Address
First Line	:	6604 N ASHLAND AVE
Second Line	:	3 J
City	:	CHICAGO
State	:	IL
Zip	:	60626-4151
Country	:	US
Telephone Number	:	773-754-5829
Fax Number	:	773-856-0319

Provider Business Practice Location Address
First Line	:	6604 N ASHLAND AVE
Second Line	:	3 J
City	:	CHICAGO
State	:	IL
Zip	:	60626-4151
Country	:	US
Telephone Number	:	773-754-5829
Fax Number	:	773-856-0319

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SANDRA DEAN
Credential	:
Telephone Number	:	773-754-5829

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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Directions to “DEAN HOMECARE LLC ” Practice Location

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