Provider Demographics
NPI:1316279037
Name:PURE HEARTS HOME HEALTH SERVICES INC.
Entity type:Organization
Organization Name:PURE HEARTS HOME HEALTH SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:BANASEN
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:773-588-1470
Mailing Address - Street 1:3839 N KEDZIE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3413
Mailing Address - Country:US
Mailing Address - Phone:773-588-1470
Mailing Address - Fax:773-588-1471
Practice Address - Street 1:3839 N KEDZIE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3413
Practice Address - Country:US
Practice Address - Phone:773-588-1470
Practice Address - Fax:773-588-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011202251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011202OtherIDPH LICENSE #