Healthcare Provider Details

I. General information

NPI: 1316047202
Provider Name (Legal Business Name): MODEL HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 WASHINGTON ST SUITE #8
DOWNERS GROVE IL
60515-4772
US

IV. Provider business mailing address

5202 WASHINGTON ST SUITE #8
DOWNERS GROVE IL
60515-4772
US

V. Phone/Fax

Practice location:
  • Phone: 630-322-8122
  • Fax: 630-322-8126
Mailing address:
  • Phone: 630-322-8122
  • Fax: 630-322-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1007244
License Number StateIL

VIII. Authorized Official

Name: MRS. CRISPINA D UNABIA
Title or Position: ADMINISTRATOR DIRECTOR OF NURSING
Credential: RN
Phone: 630-322-8122