MEDICARE: A SPECIAL FRIEND HOME HEALTHCARE AGENCY

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	041371679	IL

General Provider Information

NPI Number	:	1417397795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SPECIAL FRIEND HOME HEALTHCARE AGENCY

Provider Business Mailing Address
First Line	:	1647 S BLUE ISLAND AVE
Second Line	:	2ND FL
City	:	CHICAGO
State	:	IL
Zip	:	60608-2133
Country	:	US
Telephone Number	:	312-772-6469
Fax Number	:	773-888-3091

Provider Business Practice Location Address
First Line	:	1647 S BLUE ISLAND AVE
Second Line	:	2ND FL
City	:	CHICAGO
State	:	IL
Zip	:	60608-2133
Country	:	US
Telephone Number	:	312-772-6469
Fax Number	:	773-888-3091

Authorized Official
Title or Position	:	CEO
Name	:	CAROL ANN REED
Credential	:
Telephone Number	:	312-772-6469

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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