MEDICARE: KELLY HOME HEALTHCARE, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1811555071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY HOME HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	3325 183RD ST
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-2602
Country	:	US
Telephone Number	:	708-991-2776
Fax Number	:	708-960-0419

Provider Business Practice Location Address
First Line	:	3325 183RD ST
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-2602
Country	:	US
Telephone Number	:	708-991-2776
Fax Number	:	708-960-0419

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NNEKA GREEN
Credential	:
Telephone Number	:	708-960-0252

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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