MEDICARE: LIVING WATERS HOME HEALTH 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	251E00000X	Home Health Agency	1010420	IL

General Provider Information

NPI Number	:	1386867935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WATERS HOME HEALTH CARE INC

Provider Business Mailing Address
First Line	:	4001 W DEVON AVE
Second Line	:	SUITE 406
City	:	CHICAGO
State	:	IL
Zip	:	60646-4523
Country	:	US
Telephone Number	:	773-202-8043
Fax Number	:	773-202-8048

Provider Business Practice Location Address
First Line	:	4001 W DEVON AVE
Second Line	:	SUITE 406
City	:	CHICAGO
State	:	IL
Zip	:	60646-4523
Country	:	US
Telephone Number	:	773-202-8043
Fax Number	:	773-202-8048

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARLYN B BERMUDEZ
Credential	:	R.N.
Telephone Number	:	773-202-8043

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/31/2007

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