Provider Demographics
NPI:1063722940
Name:MEDIC HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:MEDIC HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RICA
Authorized Official - Middle Name:MIRELLA
Authorized Official - Last Name:SOMOZA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:888-207-6250
Mailing Address - Street 1:109 ROYCE RD STE D
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1405
Mailing Address - Country:US
Mailing Address - Phone:888-207-6250
Mailing Address - Fax:888-207-6251
Practice Address - Street 1:109 ROYCE RD STE D
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1405
Practice Address - Country:US
Practice Address - Phone:888-207-6250
Practice Address - Fax:888-207-6251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011325251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011325OtherILLINOIS DEPARTMENT OF HEALTH