Healthcare Provider Details

I. General information

NPI: 1477488146
Provider Name (Legal Business Name): WALTER'S HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W HARRIS AVE STE 15
LA GRANGE IL
60525-2368
US

IV. Provider business mailing address

15 W HARRIS AVE STE 15
LA GRANGE IL
60525-2368
US

V. Phone/Fax

Practice location:
  • Phone: 773-673-1211
  • Fax:
Mailing address:
  • Phone: 773-673-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: TINA M GENTRY
Title or Position: OWNER
Credential: GENTRY
Phone: 773-673-1211