MEDICARE: COMPLETE HOME HEALTH CARE, 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	1011213	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1011213	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1457667305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	2800 S WENTWORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4766
Country	:	US
Telephone Number	:	773-814-1672
Fax Number	:	312-808-1288

Provider Business Practice Location Address
First Line	:	2800 S WENTWORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4766
Country	:	US
Telephone Number	:	773-814-1672
Fax Number	:	312-808-1288

Authorized Official
Title or Position	:	AGENCY SUPERVISOR
Name	:	MISS LILY YUEN
Credential	:	R.N.
Telephone Number	:	773-814-1672

Provider Enumeration Date	:	08/28/2010
Last Update Date	:	08/28/2010

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