Provider Demographics
NPI:1851487854
Name:PROVIDENCE HOME HEALTH CARE, INC
Entity type:Organization
Organization Name:PROVIDENCE HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-480-7877
Mailing Address - Street 1:425 HUEHL RD BLDG 20
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2322
Mailing Address - Country:US
Mailing Address - Phone:847-480-7877
Mailing Address - Fax:847-714-0720
Practice Address - Street 1:425 HUEHL RD BLDG 20
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2322
Practice Address - Country:US
Practice Address - Phone:847-480-7877
Practice Address - Fax:847-714-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010131251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0001Medicaid
IL=========0001Medicaid
IL147710Medicare Oscar/Certification