MEDICARE: POTENTIAL UNLIMITED 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1811507361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTENTIAL UNLIMITED LLC

Provider Business Mailing Address
First Line	:	5140 N OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1847
Country	:	US
Telephone Number	:	773-573-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 N OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1847
Country	:	US
Telephone Number	:	773-573-4443
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KAREN STANLEY
Credential	:	OT
Telephone Number	:	773-573-4443

Provider Enumeration Date	:	08/08/2020
Last Update Date	:	08/08/2020

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