MEDICARE: CARE COLLABORATIVE HOME HEALTH SERVICES 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	IL1010250	IL

General Provider Information

NPI Number	:	1801899406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE COLLABORATIVE HOME HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	439 E 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4000
Country	:	US
Telephone Number	:	312-949-1010
Fax Number	:	312-949-9145

Provider Business Practice Location Address
First Line	:	439 E 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4000
Country	:	US
Telephone Number	:	312-949-1010
Fax Number	:	312-949-9145

Authorized Official
Title or Position	:	CFO
Name	:	MR. KEITH L. WOLSKI
Credential	:	MBA
Telephone Number	:	312-949-1010

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/14/2009

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