Healthcare Provider Details

I. General information

NPI: 1871432732
Provider Name (Legal Business Name): PRIME HEALTHCARE HOME HEALTH CARE ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20000 GOVERNORS DR STE 104
OLYMPIA FIELDS IL
60461-3001
US

IV. Provider business mailing address

20000 GOVERNORS DR STE 104
OLYMPIA FIELDS IL
60461-3001
US

V. Phone/Fax

Practice location:
  • Phone: 708-898-3500
  • Fax:
Mailing address:
  • Phone: 708-898-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER DOAN
Title or Position: MANAGING ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 310-259-4706