MEDICARE: INDEPENDENCE 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	261QH0100X	Health Service Clinic/Center	1011389	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1011389	OTHER	IL	ILLINOIS DEPARTMENT OF PUBLIC HEALTH LICENSE

General Provider Information

NPI Number	:	1831469394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	5648 W. LAWRENCE AVE,, SUITE A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3220
Country	:	US
Telephone Number	:	773-481-6525
Fax Number	:	773-481-6528

Provider Business Practice Location Address
First Line	:	5648 W LAWRENCE AVE STE A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3220
Country	:	US
Telephone Number	:	773-481-6525
Fax Number	:	773-481-6528

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. SOOMAR RAJPER
Credential	:	PT
Telephone Number	:	773-481-6525

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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