=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871890657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANSITIONS HOME MEDICAL GROUP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2011
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2312 TOUHY AVE
-----------------------------------------------------
City | ELK GROVE VILLAGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60007-5329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-515-1505
-----------------------------------------------------
Fax | 847-515-1503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8913 N PRAIRIE POINTE RD
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61615-1577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-515-1505
-----------------------------------------------------
Fax | 847-515-1503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. OMAR KHAMIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-515-1505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 209.007375
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------