Provider Demographics
NPI:1073807707
Name:LR HEALTH MANAGEMENT, INC
Entity Type:Organization
Organization Name:LR HEALTH MANAGEMENT, INC
Other - Org Name:HOME DOCTORS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIVINEGRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-375-7145
Mailing Address - Street 1:1204 S 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-1148
Mailing Address - Country:US
Mailing Address - Phone:312-375-7145
Mailing Address - Fax:708-652-5424
Practice Address - Street 1:1204 S 57TH AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-1148
Practice Address - Country:US
Practice Address - Phone:312-375-7145
Practice Address - Fax:708-652-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty