Healthcare Provider Details

I. General information

NPI: 1245332402
Provider Name (Legal Business Name): MED PLUS HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15119 WOODLAWN AVE
DOLTON IL
60419-2816
US

IV. Provider business mailing address

15119 WOODLAWN AVE
DOLTON IL
60419-2816
US

V. Phone/Fax

Practice location:
  • Phone: 708-942-1006
  • Fax: 708-942-1007
Mailing address:
  • Phone: 708-942-1006
  • Fax: 708-942-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1764076
License Number StateIL

VIII. Authorized Official

Name: MR. CURTIS PATRICK MIREE SR.
Title or Position: PRESIDENT / CEO
Credential: LNHA, LPN
Phone: 708-518-0041