Provider Demographics
NPI:1386884005
Name:PROLIFE HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:PROLIFE HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARAH JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIUMFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-807-1960
Mailing Address - Street 1:4836 MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2594
Mailing Address - Country:US
Mailing Address - Phone:847-674-1110
Mailing Address - Fax:847-674-1101
Practice Address - Street 1:4836 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2594
Practice Address - Country:US
Practice Address - Phone:847-674-1110
Practice Address - Fax:847-674-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-21
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010909251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010909OtherIDPH LICENSE NUMBER