Provider Demographics
NPI:1316320906
Name:DIANE HOME CARE, INC.
Entity type:Organization
Organization Name:DIANE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RESIDENTIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDEIANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-675-6093
Mailing Address - Street 1:4121 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4121 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3243
Practice Address - Country:US
Practice Address - Phone:847-675-0693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities