MEDICARE: AC PERFORMANCE PRO SYS HEWITT HOME CARE-AC PERF PRO

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	253Z00000X	In Home Supportive Care Agency	330483055	IL

General Provider Information

NPI Number	:	1508173535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AC PERFORMANCE PRO SYS HEWITT HOME CARE-AC PERF PRO

Provider Business Mailing Address
First Line	:	5135 S BLACKSTONE APT 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615
Country	:	US
Telephone Number	:	773-675-6381
Fax Number	:

Provider Business Practice Location Address
First Line	:	5135 S BLACKSTONE AVE APT 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-6309
Country	:	US
Telephone Number	:	773-675-6381
Fax Number	:

Authorized Official
Title or Position	:	NURSING MANAGER
Name	:	MRS. CECILY MICHELLE HEWITT
Credential	:	CNA
Telephone Number	:	773-675-6381

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	10/22/2010

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