Provider Demographics
NPI:1790949154
Name:KELLY HOME HEALTHCARE, INC
Entity Type:Organization
Organization Name:KELLY HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NNEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZURIKE-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-983-9903
Mailing Address - Street 1:3235 VOLLMER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2069
Mailing Address - Country:US
Mailing Address - Phone:708-983-9903
Mailing Address - Fax:708-960-0419
Practice Address - Street 1:3235 VOLLMER RD STE 107
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2069
Practice Address - Country:US
Practice Address - Phone:708-983-9903
Practice Address - Fax:708-960-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health