Provider Demographics
NPI:1093015646
Name:SURE CARE HOME HEALTH CORP.
Entity Type:Organization
Organization Name:SURE CARE HOME HEALTH CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYLENE
Authorized Official - Middle Name:ESMERALDA
Authorized Official - Last Name:MASICLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-295-9058
Mailing Address - Street 1:1155 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3508
Mailing Address - Country:US
Mailing Address - Phone:630-295-9058
Mailing Address - Fax:630-295-9059
Practice Address - Street 1:1155 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3508
Practice Address - Country:US
Practice Address - Phone:630-295-9058
Practice Address - Fax:630-295-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL10375251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health