MEDICARE: MIDWESTERN HEALTHCARE LTD.

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	1010551	IL

General Provider Information

NPI Number	:	1376590521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWESTERN HEALTHCARE LTD.

Provider Business Mailing Address
First Line	:	122 W SAINT CHARLES RD
Second Line	:	SUITE 4-B
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2477
Country	:	US
Telephone Number	:	630-617-0012
Fax Number	:	630-617-0023

Provider Business Practice Location Address
First Line	:	122 W SAINT CHARLES RD
Second Line	:	SUITE 4-B
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2477
Country	:	US
Telephone Number	:	630-617-0012
Fax Number	:	630-617-0023

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. AUGUSTUS LEO R HUGO
Credential	:
Telephone Number	:	630-205-3467

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	02/06/2008

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