=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699862235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESURRECTION HOME HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7420 CENTRAL AVE SUITE 2030
-----------------------------------------------------
City | RIVER FOREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60305-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-383-4663
-----------------------------------------------------
Fax | 708-763-2176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5747 DEMPSTER ST
-----------------------------------------------------
City | MORTON GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60053-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-568-4500
-----------------------------------------------------
Fax | 847-568-8635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | THOMAS L GALLUPPI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-568-8524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1008036
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------