MEDICARE: PRIME HEALTHCARE HOME HEALTH CARE ILLINOIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1871432732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HEALTHCARE HOME HEALTH CARE ILLINOIS, LLC

Provider Business Mailing Address
First Line	:	20000 GOVERNORS DR STE 104
Second Line	:
City	:	OLYMPIA FIELDS
State	:	IL
Zip	:	60461-3001
Country	:	US
Telephone Number	:	708-898-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	20000 GOVERNORS DR STE 104
Second Line	:
City	:	OLYMPIA FIELDS
State	:	IL
Zip	:	60461-3001
Country	:	US
Telephone Number	:	708-898-3500
Fax Number	:

Authorized Official
Title or Position	:	MANAGING ASSOCIATE GENERAL COUNSEL
Name	:	CHRISTOPHER DOAN
Credential	:
Telephone Number	:	310-259-4706

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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