Provider Demographics
NPI:1730952813
Name:TBF HOME HEALTH AGENCY
Entity type:Organization
Organization Name:TBF HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAKALA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:224-420-6894
Mailing Address - Street 1:9150 CRAWFORD AVE # L1
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1700
Mailing Address - Country:US
Mailing Address - Phone:224-548-0927
Mailing Address - Fax:847-556-6544
Practice Address - Street 1:9150 CRAWFORD AVE # L1
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1700
Practice Address - Country:US
Practice Address - Phone:224-548-0927
Practice Address - Fax:847-556-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty