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General NPI Number Information
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NPI Number | 1336337138
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Entity Type | Organization
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Legal Business Name | ADVANCE HOME HEALTH CARE PROVIDER CORPORATION
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Dates
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Enumeration Date | 10/06/2007
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 935 W 175TH STREET SUITE 102
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City | HOMEWOOD
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State | IL
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Zip | 60430
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Country | US
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Telephone | 630-424-9400
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Fax | 630-424-9421
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Provider Business Mailing Address
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Address Line | 935 W 175TH STREET SUITE 102
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City | HOMEWOOD
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State | IL
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Zip | 60430
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Country | US
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Telephone | 630-424-9400
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Fax | 630-424-9421
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MIR M MIRJAT
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Credential |
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Telephone | 630-424-9400
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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 | IL1010800
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License Number State | IL
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