Provider Demographics
NPI:1811555071
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:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-960-0252
Mailing Address - Street 1:3325 183RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2602
Mailing Address - Country:US
Mailing Address - Phone:708-991-2776
Mailing Address - Fax:708-960-0419
Practice Address - Street 1:3325 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2602
Practice Address - Country:US
Practice Address - Phone:708-991-2776
Practice Address - Fax:708-960-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care