Provider Demographics
NPI:1043404023
Name:WELLNESS HOME CARE, INC.
Entity Type:Organization
Organization Name:WELLNESS HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:773-779-8815
Mailing Address - Street 1:9415 S WESTERN AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-6700
Mailing Address - Country:US
Mailing Address - Phone:773-779-8815
Mailing Address - Fax:773-779-8875
Practice Address - Street 1:9415 S WESTERN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-6700
Practice Address - Country:US
Practice Address - Phone:773-779-8815
Practice Address - Fax:773-779-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-01
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010757251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148020Medicare Oscar/Certification