Basic Information
| Provider Information | |||||||||
| NPI: | 1649246224 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRIVATE HOME CARE UNLIMITED, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5517 N CUMBERLAND AVE | ||||||||
| Address2: | SUITE 915 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606564738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734676000 | ||||||||
| FaxNumber: | 7734676001 | ||||||||
| Practice Location | |||||||||
| Address1: | 5517 N CUMBERLAND AVE | ||||||||
| Address2: | SUITE 915 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606564738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734676000 | ||||||||
| FaxNumber: | 7734676001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | MASOOD | ||||||||
| AuthorizedOfficialFirstName: | SOHAIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 8004353020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KABAFUSION HOLDING LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHARM.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 1004589 | IL | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 9639 | 01 | IL | BCBSIL PROVIDER # | OTHER |