Provider Demographics
NPI:1609152867
Name:FICC HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:FICC HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-283-2835
Mailing Address - Street 1:5648 W. LAWRENCE AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3220
Mailing Address - Country:US
Mailing Address - Phone:773-283-2835
Mailing Address - Fax:773-283-2955
Practice Address - Street 1:5648 W. LAWRENCE AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3220
Practice Address - Country:US
Practice Address - Phone:773-283-2835
Practice Address - Fax:773-283-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011364261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service