Provider Demographics
NPI:1972758621
Name:PREMIUM HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:PREMIUM HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:PACITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GADIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-673-5600
Mailing Address - Street 1:7161 N CICERO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2194
Mailing Address - Country:US
Mailing Address - Phone:847-673-5600
Mailing Address - Fax:847-673-8744
Practice Address - Street 1:7161 N CICERO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2194
Practice Address - Country:US
Practice Address - Phone:847-673-5600
Practice Address - Fax:847-673-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010873251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health