MEDICARE: AVITA HOME CARE, INC

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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1316584436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVITA HOME CARE, INC

Provider Business Mailing Address
First Line	:	825 E RAND RD STE 250
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4076
Country	:	US
Telephone Number	:	773-840-5260
Fax Number	:	773-840-5209

Provider Business Practice Location Address
First Line	:	825 E RAND RD STE 250
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4076
Country	:	US
Telephone Number	:	773-840-5260
Fax Number	:	773-840-5209

Authorized Official
Title or Position	:	MANAGER
Name	:	KATERYNA RADETSKA GULLEY
Credential	:
Telephone Number	:	773-840-5260

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	01/13/2026

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Directions to “AVITA HOME CARE, INC ” Practice Location

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