MEDICARE: C & D HEALTHCARE SERVICES, 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	:	1326338633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C & D HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	327 EAST WAYNE STREET
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-2753
Country	:	US
Telephone Number	:	260-452-5163
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 EAST WAYNE STREET
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-2753
Country	:	US
Telephone Number	:	260-452-5163
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID ILO
Credential	:
Telephone Number	:	260-452-5163

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/08/2011

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