Provider Demographics
NPI:1053835694
Name:MBR IN-HOME CARE, LLC
Entity Type:Organization
Organization Name:MBR IN-HOME CARE, LLC
Other - Org Name:VISITING ANGELS OF ORLAND PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-226-1028
Mailing Address - Street 1:11532 183RD PL STE NW
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9484
Mailing Address - Country:US
Mailing Address - Phone:708-226-1028
Mailing Address - Fax:
Practice Address - Street 1:16616 S 107TH COURT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-226-1028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care