MEDICARE: IN HOME COUNSELING FOR SENIORS

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	305S00000X	Point of Service	149.015412	IL
2	302R00000X	Health Maintenance Organization	149.015412	IL

General Provider Information

NPI Number	:	1699182642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME COUNSELING FOR SENIORS

Provider Business Mailing Address
First Line	:	2318 N LOWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 N LOWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3520
Country	:	US
Telephone Number	:	773-550-3143
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	ELSA MONTOTO VEGA
Credential	:
Telephone Number	:	773-550-3143

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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Directions to “IN HOME COUNSELING FOR SENIORS ” Practice Location

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