Provider Demographics
NPI:1114464880
Name:MERIDIAN HOMECARE, INC.
Entity Type:Organization
Organization Name:MERIDIAN HOMECARE, INC.
Other - Org Name:MIDWESTERN HOMECARE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-483-8246
Mailing Address - Street 1:77 N WOLF RD
Mailing Address - Street 2:UNIT 311
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 N WOLF RD
Practice Address - Street 2:UNIT 311
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-1618
Practice Address - Country:US
Practice Address - Phone:708-483-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001317251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health