MEDICARE: HOMELAND HOMEHEALTH PROVIDER, 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	1011931	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1011931	OTHER	IL	ILLINOIS DEPARTMENT OF PUBLIC HEALTH

General Provider Information

NPI Number	:	1740430826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMELAND HOMEHEALTH PROVIDER, INC,

Provider Business Mailing Address
First Line	:	8031 N MILWAUKEE AVE STE 200
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-2827
Country	:	US
Telephone Number	:	847-983-4364
Fax Number	:	847-983-4157

Provider Business Practice Location Address
First Line	:	8031 N MILWAUKEE AVE FL 2
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-2827
Country	:	US
Telephone Number	:	847-410-2851
Fax Number	:	847-410-2720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. WARDIA KANDO
Credential	:
Telephone Number	:	847-493-9328

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	11/29/2017

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