Healthcare Provider Details

I. General information

NPI: 1699862235
Provider Name (Legal Business Name): RESURRECTION HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 CENTRAL AVE SUITE 2030
RIVER FOREST IL
60305-1800
US

IV. Provider business mailing address

5747 DEMPSTER ST
MORTON GROVE IL
60053-3056
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-4663
  • Fax: 708-763-2176
Mailing address:
  • Phone: 847-568-4500
  • Fax: 847-568-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1008036
License Number StateIL

VIII. Authorized Official

Name: THOMAS L GALLUPPI
Title or Position: CONTROLLER
Credential:
Phone: 847-568-8524