MEDICARE: HOME BOUND HEALTHCARE MEDICAL EQUIPMENT & SUPPLIES, 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	332B00000X	Durable Medical Equipment & Medical Supplies	203.000910	IL

General Provider Information

NPI Number	:	1962695924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME BOUND HEALTHCARE MEDICAL EQUIPMENT & SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	2307 W LAKE ST
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-3622
Country	:	US
Telephone Number	:	708-615-0800
Fax Number	:	708-615-0808

Provider Business Practice Location Address
First Line	:	2307 W LAKE ST
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-3622
Country	:	US
Telephone Number	:	708-615-0800
Fax Number	:	708-615-0808

Authorized Official
Title or Position	:	PRESIDENT/SECRETARY/TREASURER
Name	:	MRS. JULIETA R MITRA
Credential	:
Telephone Number	:	708-615-0800

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	03/09/2017

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