Healthcare Provider Details

I. General information

NPI: 1952110066
Provider Name (Legal Business Name): HEAL AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 MELROSE AVE STE 1
SOUTH ELGIN IL
60177-1646
US

IV. Provider business mailing address

182 MELROSE AVE STE 1
SOUTH ELGIN IL
60177-1646
US

V. Phone/Fax

Practice location:
  • Phone: 847-624-2594
  • Fax:
Mailing address:
  • Phone: 847-624-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MIA PACHECO
Title or Position: PRESIDENT
Credential: RN
Phone: 847-624-2594