MEDICARE: ILLINOIS CARE AND TRAINING 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1730500315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS CARE AND TRAINING INC.

Provider Business Mailing Address
First Line	:	4554 N BROADWAY ST STE 314
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5621
Country	:	US
Telephone Number	:	773-271-4110
Fax Number	:	773-784-5154

Provider Business Practice Location Address
First Line	:	4554 N BROADWAY ST STE 314
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5621
Country	:	US
Telephone Number	:	773-271-4110
Fax Number	:	773-784-5154

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDDIE N, NWOSU
Credential	:
Telephone Number	:	773-271-4110

Provider Enumeration Date	:	12/26/2013
Last Update Date	:	12/26/2013

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