Healthcare Provider Details

I. General information

NPI: 1093059453
Provider Name (Legal Business Name): MIRANDA HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 DEMPSTER ST STE 101A
PARK RIDGE IL
60068-8430
US

IV. Provider business mailing address

19150 S. KEDZIE AVE 203
FLOSSMOOR IL
60422-1222
US

V. Phone/Fax

Practice location:
  • Phone: 708-922-3710
  • Fax: 708-922-3715
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: INSIA TABREZI
Title or Position: ADMINISTRATOR
Credential:
Phone: 630-880-6246