Provider Demographics
NPI:1487974903
Name:ST. JOSEPH ASSYLA HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:ST. JOSEPH ASSYLA HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-217-4572
Mailing Address - Street 1:7409 CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2247
Mailing Address - Country:US
Mailing Address - Phone:630-964-4460
Mailing Address - Fax:630-964-4463
Practice Address - Street 1:7409 CHESTNUT CT
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2247
Practice Address - Country:US
Practice Address - Phone:630-964-4460
Practice Address - Fax:630-964-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011207251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health