Healthcare Provider Details

I. General information

NPI: 1780989145
Provider Name (Legal Business Name): CONNIE HOME HEALTH CARE,NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21220 MAPLE ST
MATTESON IL
60443-2532
US

IV. Provider business mailing address

21220 MAPLE ST
MATTESON IL
60443-2532
US

V. Phone/Fax

Practice location:
  • Phone: 708-790-4000
  • Fax:
Mailing address:
  • Phone: 708-790-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LINDA FLEMING
Title or Position: CEO
Credential:
Phone: 708-790-4000