MEDICARE: PREMIER CHOICE HOMES NFP CORP

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1932095619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CHOICE HOMES NFP CORP

Provider Business Mailing Address
First Line	:	7260 W BENTON DR
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-9303
Country	:	US
Telephone Number	:	708-564-9800
Fax Number	:	708-810-9747

Provider Business Practice Location Address
First Line	:	7260 W BENTON DR
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-9303
Country	:	US
Telephone Number	:	708-564-9800
Fax Number	:	708-810-9747

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	AISHA O NOAH
Credential	:
Telephone Number	:	312-221-1269

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	06/17/2025

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