Provider Demographics
NPI:1093958365
Name:MEDSTAR HOME HEALTH SERVICES LTD.
Entity Type:Organization
Organization Name:MEDSTAR HOME HEALTH SERVICES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OBED
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-226-2828
Mailing Address - Street 1:1019 W FULTON MARKET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1222
Mailing Address - Country:US
Mailing Address - Phone:312-226-2828
Mailing Address - Fax:312-226-1222
Practice Address - Street 1:1019 W FULTON MARKET
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1222
Practice Address - Country:US
Practice Address - Phone:312-226-2828
Practice Address - Fax:312-226-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health