MEDICARE: TSN HOME CARE LLC

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	:	1790455756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TSN HOME CARE LLC

Provider Business Mailing Address
First Line	:	2100 SIBLEY BLVD STE 103
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2153
Country	:	US
Telephone Number	:	708-360-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 SIBLEY BLVD STE 103 ROOM 2
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2153
Country	:	US
Telephone Number	:	708-360-3369
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAMEKA NEEDHAM
Credential	:
Telephone Number	:	708-360-3369

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/21/2021

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