Provider Demographics
NPI:1003342742
Name:HOMECARE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:HOMECARE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEHNIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-415-6581
Mailing Address - Street 1:1030 N STATE ST
Mailing Address - Street 2:17H
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5476
Mailing Address - Country:US
Mailing Address - Phone:224-415-6581
Mailing Address - Fax:
Practice Address - Street 1:1030 N STATE ST
Practice Address - Street 2:17H
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5476
Practice Address - Country:US
Practice Address - Phone:224-415-6581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization