MEDICARE: PENTACARE THERAPY SERVICES

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
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1689029779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENTACARE THERAPY SERVICES

Provider Business Mailing Address
First Line	:	8921 NATIONAL AVE
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2028
Country	:	US
Telephone Number	:	312-451-8175
Fax Number	:

Provider Business Practice Location Address
First Line	:	8921 NATIONAL AVE
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2028
Country	:	US
Telephone Number	:	312-451-8175
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AIJO VINCENT
Credential	:
Telephone Number	:	312-451-8175

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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