Provider Demographics
NPI:1033380175
Name:CONVERGE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:CONVERGE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NERJA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-375-0323
Mailing Address - Street 1:1100 E WOODFIELD RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5116
Mailing Address - Country:US
Mailing Address - Phone:847-375-0323
Mailing Address - Fax:847-330-2844
Practice Address - Street 1:1100 E WOODFIELD RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5116
Practice Address - Country:US
Practice Address - Phone:847-375-0323
Practice Address - Fax:847-330-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010849251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010849OtherSTATE LICENSE