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General NPI Number Information
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NPI Number | 1124381967
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Entity Type | Organization
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Legal Business Name | OPAL HOME HEALTH, LLC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 4403 W LAWRENCE AVE SUITE 201
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City | CHICAGO
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State | IL
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Zip | 60630-2513
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Country | US
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Telephone | 773-283-3074
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Fax | 773-283-2986
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Provider Business Mailing Address
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Address Line | 4403 W LAWRENCE AVE SUITE 201
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City | CHICAGO
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State | IL
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Zip | 60630-2513
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Country | US
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Telephone | 773-283-3074
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Fax | 773-283-2986
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Authorized Official
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Title or Position | AGENCY ADMINISTRATOR
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Name | MISS ELSIE PAEZ
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Credential | BSN, RN
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Telephone | 773-283-3074
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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 | 1011510
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License Number State | IL
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