Provider Demographics
NPI:1093877656
Name:SUBURBAN HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:SUBURBAN HOME HEALTH CARE, INC.
Other - Org Name:BIG HEART HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:ELKOSSEI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-907-3912
Mailing Address - Street 1:9318 S KEDZIE AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2323
Mailing Address - Country:US
Mailing Address - Phone:708-907-3912
Mailing Address - Fax:708-907-3915
Practice Address - Street 1:9318 S KEDZIE AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2323
Practice Address - Country:US
Practice Address - Phone:708-907-3912
Practice Address - Fax:708-907-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011617251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D1023779OtherCLIA