Provider Demographics
NPI:1306800537
Name:CENTRAL PREFERRED HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:CENTRAL PREFERRED HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BIBIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-965-0364
Mailing Address - Street 1:9030 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2406
Mailing Address - Country:US
Mailing Address - Phone:847-965-0364
Mailing Address - Fax:847-965-0354
Practice Address - Street 1:9030 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2406
Practice Address - Country:US
Practice Address - Phone:847-965-0364
Practice Address - Fax:847-965-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1007152251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147672Medicare Oscar/Certification
IL14-7672Medicare PIN