Healthcare Provider Details

I. General information

NPI: 1831860626
Provider Name (Legal Business Name): SPRING HOME HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 W PETERSON AVE STE 6
CHICAGO IL
60659-4032
US

IV. Provider business mailing address

2622 W PETERSON AVE STE 6
CHICAGO IL
60659-4032
US

V. Phone/Fax

Practice location:
  • Phone: 773-654-1678
  • Fax: 773-943-6352
Mailing address:
  • Phone: 773-654-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: OMOLOLA I ASIELUE
Title or Position: ADMINISTRATOR
Credential: DR
Phone: 773-654-1678