Healthcare Provider Details

I. General information

NPI: 1982189395
Provider Name (Legal Business Name): SAINT LOUIS HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 E INDEPENDENCE DR
PALATINE IL
60074-1959
US

IV. Provider business mailing address

739 E INDEPENDENCE DR APT 4
PALATINE IL
60074-1959
US

V. Phone/Fax

Practice location:
  • Phone: 312-605-0168
  • Fax:
Mailing address:
  • Phone: 312-605-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GARIK KHACHATRYAN
Title or Position: PRESIDENT
Credential:
Phone: 312-605-0168