MEDICARE: TEE HOME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1891196234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEE HOME CARE INC.

Provider Business Mailing Address
First Line	:	16310 S LINCOLN HWY
Second Line	:	UNIT 106
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-9006
Country	:	US
Telephone Number	:	815-609-1122
Fax Number	:	815-609-0076

Provider Business Practice Location Address
First Line	:	16310 S LINCOLN HWY
Second Line	:	UNIT 106
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-9006
Country	:	US
Telephone Number	:	815-609-1122
Fax Number	:	815-609-0076

Authorized Official
Title or Position	:	OWNER/AGENCY MANAGER
Name	:	MRS. BRENDA L ERICSON
Credential	:
Telephone Number	:	815-609-1122

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/04/2014

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