Healthcare Provider Details

I. General information

NPI: 1124388087
Provider Name (Legal Business Name): GEORGETOWN HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E ALGONQUIN RD STE 106
ALGONQUIN IL
60102-9632
US

IV. Provider business mailing address

1700 E ALGONQUIN RD STE 106
ALGONQUIN IL
60102-9632
US

V. Phone/Fax

Practice location:
  • Phone: 224-678-9772
  • Fax: 224-333-0496
Mailing address:
  • Phone: 224-678-9772
  • Fax: 224-333-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1011506
License Number StateIL

VIII. Authorized Official

Name: MOPELOLA AGBOJE
Title or Position: ADMINISTRATOR
Credential:
Phone: 224-678-9772