Healthcare Provider Details

I. General information

NPI: 1942985270
Provider Name (Legal Business Name): RESURRECTION HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W 95TH ST STE B1
OAK LAWN IL
60453-2402
US

IV. Provider business mailing address

6007 N SHERIDAN RD APT 15K
CHICAGO IL
60660-3063
US

V. Phone/Fax

Practice location:
  • Phone: 773-656-9848
  • Fax:
Mailing address:
  • Phone: 312-451-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ERNESTO V ESTOR
Title or Position: PRESIDENT
Credential: MD
Phone: 312-451-4971