MEDICARE: MIDWEST PEARL HOME HEALTHCARE 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	251E00000X	Home Health Agency	IL1010485	IL

General Provider Information

NPI Number	:	1669521654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST PEARL HOME HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1925 N HARLEM AVE
Second Line	:	SUITE 108
City	:	CHICAGO
State	:	IL
Zip	:	60707-3743
Country	:	US
Telephone Number	:	773-237-2655
Fax Number	:	773-237-2717

Provider Business Practice Location Address
First Line	:	1925 N HARLEM AVE
Second Line	:	SUITE 101
City	:	CHICAGO
State	:	IL
Zip	:	60707-3743
Country	:	US
Telephone Number	:	773-237-2655
Fax Number	:	773-237-2717

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. NELVA DURAN REYES
Credential	:
Telephone Number	:	773-237-2655

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	09/16/2008

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