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General NPI Number Information
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NPI Number | 1124388087
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Entity Type | Organization
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Legal Business Name | GEORGETOWN HOME HEALTH CARE INC
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 1700 E ALGONQUIN RD STE 106
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City | ALGONQUIN
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State | IL
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Zip | 60102-9632
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Country | US
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Telephone | 224-678-9772
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Fax | 224-333-0496
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Provider Business Mailing Address
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Address Line | 1700 E ALGONQUIN RD STE 106
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City | ALGONQUIN
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State | IL
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Zip | 60102-9632
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Country | US
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Telephone | 224-678-9772
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Fax | 224-333-0496
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MOPELOLA AGBOJE
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Credential |
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Telephone | 224-678-9772
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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 | 1011506
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License Number State | IL
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