Provider Demographics
NPI:1104855238
Name:ALLIANCE HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:ALLIANCE HOME HEALTHCARE INC
Other - Org Name:ALLIANCE HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-585-8100
Mailing Address - Street 1:6457 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5148
Mailing Address - Country:US
Mailing Address - Phone:773-585-8100
Mailing Address - Fax:773-585-9928
Practice Address - Street 1:6457 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5148
Practice Address - Country:US
Practice Address - Phone:773-585-8100
Practice Address - Fax:773-585-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1007145251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147615Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER