Provider Demographics
NPI:1285912022
Name:ORCHID HOME HEALTH, INC
Entity type:Organization
Organization Name:ORCHID HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:LOZADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-646-9154
Mailing Address - Street 1:4007 N BROADWAY ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6074
Mailing Address - Country:US
Mailing Address - Phone:312-646-9154
Mailing Address - Fax:312-254-1411
Practice Address - Street 1:4007 N BROADWAY ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6074
Practice Address - Country:US
Practice Address - Phone:312-646-9154
Practice Address - Fax:312-254-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011377251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health