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NPI Code Detail

MEDICARE: INNOVATIVE SENIOR CARE HOME HEALTH OF CHICAGO, LLC

MEDICARE: INNOVATIVE SENIOR CARE HOME HEALTH OF CHICAGO, 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
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1417622705
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATIVE SENIOR CARE HOME HEALTH OF CHICAGO, LLC
Provider Business Mailing Address
First Line : PO BOX 51266
Second Line :
City : LAFAYETTE
State : LA
Zip : 70505-1266
Country : US
Telephone Number : 337-233-1307
Fax Number : 337-443-4154
Provider Business Practice Location Address
First Line : 1111 ONTARIO ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-1939
Country : US
Telephone Number : 708-934-7149
Fax Number : 708-934-7148
Authorized Official
Title or Position : PRESIDENT
Name : JOSHUA L. PROFFITT
Credential :
Telephone Number : 337-233-1307
Provider Enumeration Date : 08/10/2021
Last Update Date : 10/02/2024

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Directions to “INNOVATIVE SENIOR CARE HOME HEALTH OF CHICAGO, LLC ” Practice Location

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