MEDICARE: CARE AT HOME

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	2129082	IL

General Provider Information

NPI Number	:	1669743100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE AT HOME

Provider Business Mailing Address
First Line	:	7115 S SAWYER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-3535
Country	:	US
Telephone Number	:	773-980-3268
Fax Number	:	773-778-5433

Provider Business Practice Location Address
First Line	:	7115 S SAWYER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-3535
Country	:	US
Telephone Number	:	773-980-3268
Fax Number	:	773-778-5433

Authorized Official
Title or Position	:	CEO
Name	:	MS. AGNES COLLIER
Credential	:	CNA
Telephone Number	:	773-209-7316

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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Directions to “CARE AT HOME ” Practice Location

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