Healthcare Provider Details

I. General information

NPI: 1558447920
Provider Name (Legal Business Name): EMMANUEL HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 LAKE PLUMLEIGH WAY
ALGONQUIN IL
60102-5018
US

IV. Provider business mailing address

610 LAKE PLUMLEIGH WAY
ALGONQUIN IL
60102-5018
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-3980
  • Fax: 847-658-6093
Mailing address:
  • Phone: 847-658-3980
  • Fax: 847-658-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010621
License Number StateIL

VIII. Authorized Official

Name: ROSE SHARON CORDERO
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 847-658-3980