Provider Demographics
NPI:1326826751
Name:HALL OF FAME CARE ASSOCIATION
Entity Type:Organization
Organization Name:HALL OF FAME CARE ASSOCIATION
Other - Org Name:AMADA SENIOR CARE ELGIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-323-3878
Mailing Address - Street 1:75 MARKET ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5021
Mailing Address - Country:US
Mailing Address - Phone:630-948-4838
Mailing Address - Fax:
Practice Address - Street 1:75 MARKET ST STE 5
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5021
Practice Address - Country:US
Practice Address - Phone:630-948-4838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty