Healthcare Provider Details

I. General information

NPI: 1144461906
Provider Name (Legal Business Name): ALPHONSA HOME HEALTH CARE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2009
Last Update Date: 03/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 N WILLOW RD
ELMHURST IL
60126-1766
US

IV. Provider business mailing address

743 N WILLOW RD
ELMHURST IL
60126-1766
US

V. Phone/Fax

Practice location:
  • Phone: 630-758-4077
  • Fax: 630-758-4078
Mailing address:
  • Phone: 630-758-4077
  • Fax: 630-758-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1011063
License Number StateIL

VIII. Authorized Official

Name: MRS. AISHAMMA LAWRENCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 630-758-4077