Provider Demographics
NPI:1437571932
Name:HOME FOR GOOD SENIOR CARE, INC.
Entity Type:Organization
Organization Name:HOME FOR GOOD SENIOR CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-572-4875
Mailing Address - Street 1:6246 N PULASKI RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5100
Mailing Address - Country:US
Mailing Address - Phone:773-572-4875
Mailing Address - Fax:
Practice Address - Street 1:6246 N PULASKI RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5100
Practice Address - Country:US
Practice Address - Phone:773-572-4875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1819074253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care