Provider Demographics
NPI:1992912182
Name:ICARE HOME HEALTH CORPORATION
Entity type:Organization
Organization Name:ICARE HOME HEALTH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN-RN
Authorized Official - Phone:773-334-2515
Mailing Address - Street 1:5962 N LINCOLN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3711
Mailing Address - Country:US
Mailing Address - Phone:773-334-2515
Mailing Address - Fax:773-334-2516
Practice Address - Street 1:5962 N LINCOLN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3711
Practice Address - Country:US
Practice Address - Phone:773-334-2515
Practice Address - Fax:773-334-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011369251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148039Medicare Oscar/Certification