MEDICARE: HOME BOUND 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	291U00000X	Clinical Medical Laboratory	14D1036623
2	251E00000X	Home Health Agency	1010413	IL
3	251E00000X	Home Health Agency	1011897	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1010413	OTHER	IL	HOME HEALTH AGENCY LIC
2	14D1036623	OTHER		CLIA CERT OF WAIVER

General Provider Information

NPI Number	:	1710958533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME BOUND HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	14216 MCCARTHY RD UNIT A
Second Line	:
City	:	LEMONT
State	:	IL
Zip	:	60439-9393
Country	:	US
Telephone Number	:	708-798-0800
Fax Number	:	708-798-0870

Provider Business Practice Location Address
First Line	:	14216 MCCARTHY RD UNIT A
Second Line	:
City	:	LEMONT
State	:	IL
Zip	:	60439-9393
Country	:	US
Telephone Number	:	708-798-0800
Fax Number	:	708-798-0870

Authorized Official
Title or Position	:	PRESIDENT/SECRETARY/TREASURER
Name	:	MRS. JULIETA MITRA JR.
Credential	:
Telephone Number	:	708-798-0800

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	02/01/2017

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Directions to “HOME BOUND HEALTHCARE, INC. ” Practice Location

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