MEDICARE: MID-CARE, 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	1010552	IL

General Provider Information

NPI Number	:	1871521526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-CARE, INC.

Provider Business Mailing Address
First Line	:	4006 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3905
Country	:	US
Telephone Number	:	773-202-0195
Fax Number	:	773-202-0197

Provider Business Practice Location Address
First Line	:	4006 W ADDISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3905
Country	:	US
Telephone Number	:	773-202-0195
Fax Number	:	773-202-0197

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MRS. MYRNA A. CORDERO
Credential	:	R.N.
Telephone Number	:	773-202-0195

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	08/06/2007

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