MEDICARE: ST THOMAS HEALTH 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

General Provider Information

NPI Number	:	1912929845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST THOMAS HEALTH CARE INC

Provider Business Mailing Address
First Line	:	4554 N BROADWAY ST STE 312
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5621
Country	:	US
Telephone Number	:	773-769-2820
Fax Number	:	773-271-3678

Provider Business Practice Location Address
First Line	:	4554 N BROADWAY ST STE 312
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5621
Country	:	US
Telephone Number	:	773-769-2820
Fax Number	:	773-271-3678

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ESTHER TAKANG
Credential	:	RN
Telephone Number	:	773-895-2951

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	08/30/2022

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