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Organization
ITARA42 HOME CARE AGENCY
Active
Organization
ITARA42 HOME CARE AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DON DAVIS (MANAGER)
(773) 999-5051
Entity
Organization
Contact information
Practice address
12051 S YALE AVE, CHICAGO, IL 60628-6536
(773) 840-3729
Mailing address
25 E 16TH ST, CHICAGO HEIGHTS, IL 60411-3410
(773) 999-5051
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
347C00000X
Private Vehicle
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
04/21/2025
Last updated
04/22/2025
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