Provider Demographics
NPI:1063402154
Name:CHOICECARE HOME HEALTH, INC.
Entity type:Organization
Organization Name:CHOICECARE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHOLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-489-0123
Mailing Address - Street 1:6400 COLLEGE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-489-0123
Mailing Address - Fax:708-489-2239
Practice Address - Street 1:6400 W COLLEGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1785
Practice Address - Country:US
Practice Address - Phone:708-489-0123
Practice Address - Fax:708-489-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 253Z00000X, 385H00000X
IL1010179251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50113OtherBLUE CROSS PROVIDER #
IL14-7720Medicare ID - Type UnspecifiedMC PROVIDER #