MEDICARE: WHOLE LIFE HOME HEALTH 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	1011053	IL

General Provider Information

NPI Number	:	1417189838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE LIFE HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	2860 S RIVER RD STE 270
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-6002
Country	:	US
Telephone Number	:	847-588-2111
Fax Number	:	847-588-1147

Provider Business Practice Location Address
First Line	:	2860 S RIVER RD STE 270
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-6002
Country	:	US
Telephone Number	:	847-588-2111
Fax Number	:	847-588-1147

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	TONY CHACKO KOCHUPARAMBIL
Credential	:
Telephone Number	:	847-588-2111

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	05/19/2023

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Directions to “WHOLE LIFE HOME HEALTH LLC ” Practice Location

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