MEDICARE: THE CHILDREN'S PLACE HOME HEALTH ASSOCIATION

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	163WP0200X	Pediatric Registered Nurse	1009372	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1009372	OTHER	IL	HOME HEALTH AGENCY SKILLED NURSING MEDICAL SOCIAL SERVICES

General Provider Information

NPI Number	:	1790710010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILDREN'S PLACE HOME HEALTH ASSOCIATION

Provider Business Mailing Address
First Line	:	3059 W. AUGUSTA
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	773-826-1230
Fax Number	:	773-826-0705

Provider Business Practice Location Address
First Line	:	3059 W. AUGUSTA
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	773-826-1230
Fax Number	:	773-826-0705

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MRS. CATHY KRIEGER
Credential	:
Telephone Number	:	312-660-3021

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/20/2013

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