Healthcare Provider Details

I. General information

NPI: 1437330305
Provider Name (Legal Business Name): PHYSICIAN HOME CARE SERVICES PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FAIRFIELD WAY SUITE 207
BLOOMINGDALE IL
60108-1588
US

IV. Provider business mailing address

121 FAIRFIELD WAY SUITE 207
BLOOMINGDALE IL
60108-1243
US

V. Phone/Fax

Practice location:
  • Phone: 630-529-7427
  • Fax: 630-529-9937
Mailing address:
  • Phone: 630-529-7427
  • Fax: 630-529-9937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number216022
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036081593
License Number StateIL

VIII. Authorized Official

Name: MRS. RONALYN PELAEZ STEPHEN
Title or Position: PRESIDENT / CEO
Credential:
Phone: 630-529-7427