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NPI Code Detail

MEDICARE: MCH OF ILLINOIS, INC.

MEDICARE: MCH OF ILLINOIS, 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
1251E00000XHome Health Agency1010132IL

General Provider Information

NPI Number : 1467443358
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCH OF ILLINOIS, INC.
Provider Business Mailing Address
First Line : PO BOX 16809
Second Line :
City : HATTIESBURG
State : MS
Zip : 39404-6809
Country : US
Telephone Number : 601-268-1842
Fax Number : 601-268-7898
Provider Business Practice Location Address
First Line : 8145 RIVER DR
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-2645
Country : US
Telephone Number : 888-345-7337
Fax Number : 847-966-1240
Authorized Official
Title or Position : VICE PRESIDENT OF OPERATIONS
Name : MS. NANCY C JAKUS
Credential : RN BSN MBA
Telephone Number : 601-268-1842
Provider Enumeration Date : 10/31/2005
Last Update Date : 08/22/2020

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