Provider Demographics
NPI:1053445320
Name:FJ HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:FJ HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-581-3500
Mailing Address - Street 1:4507 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2621
Mailing Address - Country:US
Mailing Address - Phone:708-581-3500
Mailing Address - Fax:708-581-3505
Practice Address - Street 1:4507 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2621
Practice Address - Country:US
Practice Address - Phone:708-581-3500
Practice Address - Fax:708-581-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50270OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL147737Medicare ID - Type Unspecified