MEDICARE: IGOCARE, 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
1	253Z00000X	In Home Supportive Care Agency	3001019	IL

General Provider Information

NPI Number	:	1609293653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IGOCARE, INC

Provider Business Mailing Address
First Line	:	6352 N LINCOLN AVE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60659-1213
Country	:	US
Telephone Number	:	773-775-4677
Fax Number	:	773-775-4687

Provider Business Practice Location Address
First Line	:	6352 N LINCOLN AVE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60659-1213
Country	:	US
Telephone Number	:	773-775-4677
Fax Number	:	773-775-4687

Authorized Official
Title or Position	:	GENERAL MANAGER, OWNER
Name	:	MRS. HEATHER ANN LANTRY
Credential	:	NCC, MT-BC, NMT
Telephone Number	:	773-775-4677

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/27/2014

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