Healthcare Provider Details

I. General information

NPI: 1093741415
Provider Name (Legal Business Name): REGENCY HOME HEALTH CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10448 S PULASKI RD SUITE 4
OAK LAWN IL
60453-4895
US

IV. Provider business mailing address

6060 W. 95TH STREET
OAK LAWN IL
60453-2778
US

V. Phone/Fax

Practice location:
  • Phone: 708-952-1052
  • Fax: 708-952-1053
Mailing address:
  • Phone: 708-398-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number070-007492
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010758
License Number StateIL

VIII. Authorized Official

Name: AHMED MOHAMED
Title or Position: ADMINISTRATOR
Credential: P.T.
Phone: 708-398-4022