Healthcare Provider Details

I. General information

NPI: 1104737055
Provider Name (Legal Business Name): DEPACE HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8017 W BELMONT AVE
RIVER GROVE IL
60171
US

IV. Provider business mailing address

8017 W BELMONT AVE
RIVER GROVE IL
60171
US

V. Phone/Fax

Practice location:
  • Phone: 312-522-5722
  • Fax:
Mailing address:
  • Phone: 312-522-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OYINUA DUMAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 312-522-5722