Provider Demographics
NPI:1992145031
Name:CHRIST MISSIONARY HOME HEALTH AGENCY, INC.
Entity type:Organization
Organization Name:CHRIST MISSIONARY HOME HEALTH AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER / DIRECTOR/ PRESIDENT/
Authorized Official - Prefix:PROF
Authorized Official - First Name:MELLONY
Authorized Official - Middle Name:LASHON
Authorized Official - Last Name:GANT
Authorized Official - Suffix:
Authorized Official - Credentials:HOME CARE SERVICES
Authorized Official - Phone:312-566-1888
Mailing Address - Street 1:PO BOX 368218
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636-8218
Mailing Address - Country:US
Mailing Address - Phone:312-566-1888
Mailing Address - Fax:
Practice Address - Street 1:3121 W 71ST ST APT 2FRONT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-3003
Practice Address - Country:US
Practice Address - Phone:312-566-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid