MEDICARE: DOMINION HOME HEALTH CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		IL
2	251E00000X	Home Health Agency	1011216	IL

General Provider Information

NPI Number	:	1295062404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION HOME HEALTH CARE INC.

Provider Business Mailing Address
First Line	:	3434 RIDGE RD
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-3102
Country	:	US
Telephone Number	:	708-858-6132
Fax Number	:	708-858-6156

Provider Business Practice Location Address
First Line	:	3434 RIDGE RD
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-3102
Country	:	US
Telephone Number	:	708-858-6132
Fax Number	:	708-858-6156

Authorized Official
Title or Position	:	ADMINISTATOR
Name	:	VICTOR OKEZIE IKE
Credential	:
Telephone Number	:	708-527-0808

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	11/11/2024

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