=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376708412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BG HOME HEALTH PROVIDERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2008
-----------------------------------------------------
Last Update Date | 12/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 139 W RAND RD
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60004-3142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-565-5035
-----------------------------------------------------
Fax | 847-656-5012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 W RAND RD
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60004-3142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-565-5035
-----------------------------------------------------
Fax | 847-656-5012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. LUCYNA A BIGAJ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-656-5035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010915
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------