Healthcare Provider Details

I. General information

NPI: 1780434456
Provider Name (Legal Business Name): HOME GROWN PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N CLEVELAND AVE APT 711
CHICAGO IL
60610-3663
US

IV. Provider business mailing address

808 N CLEVELAND AVE APT 711
CHICAGO IL
60610-3663
US

V. Phone/Fax

Practice location:
  • Phone: 815-641-0435
  • Fax:
Mailing address:
  • Phone: 815-641-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KAETLIN L ROMBERG
Title or Position: OWNER/ THERAPIST
Credential: M.ED.
Phone: 815-641-0435