Provider Demographics
NPI:1124037569
Name:CHICAGO HOME HEALTHCARE AGENCY LTD
Entity type:Organization
Organization Name:CHICAGO HOME HEALTHCARE AGENCY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NKEMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-734-9833
Mailing Address - Street 1:2403 EAST 75TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649
Mailing Address - Country:US
Mailing Address - Phone:773-734-9833
Mailing Address - Fax:773-734-8880
Practice Address - Street 1:2403 EAST 75TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649
Practice Address - Country:US
Practice Address - Phone:773-734-9833
Practice Address - Fax:773-734-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010221251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50239OtherBLUE CROSS BLUE SHIELD
3104Medicare PIN
IL50239OtherBLUE CROSS BLUE SHIELD