Healthcare Provider Details

I. General information

NPI: 1205125838
Provider Name (Legal Business Name): GEORGETOWN HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E. ALGONQUIN ROAD SUITE 106
ALGONQUIN IL
60102
US

IV. Provider business mailing address

1700 E. ALGONQUIN ROAD SUITE 106
ALGONQUIN IL
60102
US

V. Phone/Fax

Practice location:
  • Phone: 708-212-2719
  • Fax:
Mailing address:
  • Phone: 708-212-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number201124
License Number StateIL

VIII. Authorized Official

Name: MRS. MOPELOLA AGBOJE
Title or Position: D.O.N.
Credential:
Phone: 708-212-2719