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General NPI Number Information
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NPI Number | 1548375447
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Entity Type | Organization
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Legal Business Name | MEDTEC HOME HEALTH AGENCY, INC.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 10001 W ROOSEVELT RD STE 306
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City | WESTCHESTER
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State | IL
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Zip | 60154-2662
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Country | US
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Telephone | 708-681-2009
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Fax | 708-575-2166
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Provider Business Mailing Address
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Address Line | 10001 W ROOSEVELT RD STE 306
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City | WESTCHESTER
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State | IL
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Zip | 60154-2662
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Country | US
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Telephone | 708-681-2009
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Fax | 708-575-2166
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CYNTHIA PRABHAKAR
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Credential |
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Telephone | 708-681-2009
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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 | 1010201
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License Number State | IL
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