Healthcare Provider Details

I. General information

NPI: 1750159265
Provider Name (Legal Business Name): SUGAR HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOLIDAY PLAZA DR STE 182
MATTESON IL
60443-2236
US

IV. Provider business mailing address

600 HOLIDAY PLAZA DR STE 182
MATTESON IL
60443-2236
US

V. Phone/Fax

Practice location:
  • Phone: 312-924-1831
  • Fax: 312-923-1832
Mailing address:
  • Phone: 312-924-1831
  • Fax: 312-923-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1012167
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerIDPH
# 2
Identifier14D2251718
Identifier TypeOTHER
Identifier State
Identifier IssuerCLIA

VIII. Authorized Official

Name: ERICA ROBINSON
Title or Position: CEO
Credential:
Phone: 773-828-3093