MEDICARE: LIFE PLUS HEALTH CARE 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	1736532	IL

General Provider Information

NPI Number	:	1689682460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE PLUS HEALTH CARE INC

Provider Business Mailing Address
First Line	:	2714 W PETERSON AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3920
Country	:	US
Telephone Number	:	773-764-3311
Fax Number	:	773-764-3340

Provider Business Practice Location Address
First Line	:	2714 W PETERSON AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3920
Country	:	US
Telephone Number	:	773-764-3311
Fax Number	:	773-764-3340

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. NANCY NAOE SAN JUAN
Credential	:	RN
Telephone Number	:	773-764-3311

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	02/09/2009

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