Provider Demographics
NPI:1699862235
Name:RESURRECTION HOME HEALTH SERVICES
Entity type:Organization
Organization Name:RESURRECTION HOME HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLUPPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-568-8524
Mailing Address - Street 1:5747 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3056
Mailing Address - Country:US
Mailing Address - Phone:847-568-4500
Mailing Address - Fax:847-568-8635
Practice Address - Street 1:7420 CENTRAL AVE
Practice Address - Street 2:SUITE 2030
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1800
Practice Address - Country:US
Practice Address - Phone:708-383-4663
Practice Address - Fax:708-763-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1008036251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid