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General NPI Number Information
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NPI Number | 1114464880
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Entity Type | Organization
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Legal Business Name | MERIDIAN HOMECARE, INC.
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 77 N WOLF RD UNIT 311
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City | NORTHLAKE
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State | IL
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Zip | 60164-1618
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Country | US
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Telephone | 708-483-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 77 N WOLF RD UNIT 311
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City | NORTHLAKE
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State | IL
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Zip | 60164-1618
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEO HUGO
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Credential |
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Telephone | 708-483-8246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3001317
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License Number State | IL
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