MEDICARE: PREMIER HOMECARE SUPPLIES, LTD

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	5778	IL

General Provider Information

NPI Number	:	1982602207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HOMECARE SUPPLIES, LTD

Provider Business Mailing Address
First Line	:	8048 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-2603
Country	:	US
Telephone Number	:	773-776-9941
Fax Number	:	773-776-9953

Provider Business Practice Location Address
First Line	:	8048 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-2603
Country	:	US
Telephone Number	:	773-776-9941
Fax Number	:	773-776-9953

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TONY ZAKHEM
Credential	:
Telephone Number	:	773-776-9941

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/19/2011

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