Provider Demographics
NPI:1295465060
Name:HOMECARE AND HAIR LLC
Entity Type:Organization
Organization Name:HOMECARE AND HAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CLESHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:CMAA
Authorized Official - Phone:312-777-9105
Mailing Address - Street 1:PO BOX 607004
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-0961
Mailing Address - Country:US
Mailing Address - Phone:773-640-7474
Mailing Address - Fax:
Practice Address - Street 1:3432 W DIVERSEY AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1221
Practice Address - Country:US
Practice Address - Phone:312-777-9105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty