Healthcare Provider Details

I. General information

NPI: 1457677353
Provider Name (Legal Business Name): FMR HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 S 17TH AVE FL 1
BROADVIEW IL
60155-3020
US

IV. Provider business mailing address

2122 S 17TH AVE FL 1
BROADVIEW IL
60155-3020
US

V. Phone/Fax

Practice location:
  • Phone: 708-562-0192
  • Fax: 708-562-0365
Mailing address:
  • Phone: 708-562-0192
  • Fax: 708-562-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MERLE GUARTE MALANYAON
Title or Position: AGENCY SUPERVISOR/PRESIDENT
Credential: RN, BSN
Phone: 708-562-0192