Healthcare Provider Details

I. General information

NPI: 1447491519
Provider Name (Legal Business Name): HOME LIFE HEALTHCARE, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W GOLF RD
HOFFMAN ESTATES IL
60169-1340
US

IV. Provider business mailing address

1020 W GOLF RD
HOFFMAN ESTATES IL
60169-1340
US

V. Phone/Fax

Practice location:
  • Phone: 847-413-1611
  • Fax: 847-908-9011
Mailing address:
  • Phone: 847-413-1611
  • Fax: 847-908-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010985
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number1010985
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000861
License Number StateIL

VIII. Authorized Official

Name: RAJ MAHTANI
Title or Position: HEALTHCARE ADMINISTRATOR
Credential:
Phone: 847-143-1611