Provider Demographics
NPI:1588655468
Name:VNA HOME HEALTH OF ILLINOIS LTD
Entity type:Organization
Organization Name:VNA HOME HEALTH OF ILLINOIS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENEGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:866-676-3931
Mailing Address - Street 1:200 HOWARD AVE
Mailing Address - Street 2:SUITE 248
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5906
Mailing Address - Country:US
Mailing Address - Phone:866-676-3931
Mailing Address - Fax:847-803-0821
Practice Address - Street 1:215 N CONVENT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5600
Practice Address - Country:US
Practice Address - Phone:877-908-1606
Practice Address - Fax:815-932-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1009513251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========AAMedicaid
IL147708Medicare ID - Type UnspecifiedMEDICARE