MEDICARE: CROWN HOME HEALTH SERVICES 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	:	1881303113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1 E SUPERIOR ST STE 504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2593
Country	:	US
Telephone Number	:	312-888-3965
Fax Number	:	312-846-1267

Provider Business Practice Location Address
First Line	:	1 E SUPERIOR ST STE 504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2593
Country	:	US
Telephone Number	:	312-888-3965
Fax Number	:	312-846-1267

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL TROST
Credential	:
Telephone Number	:	312-888-3965

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	01/23/2023

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