Provider Demographics
NPI:1124381967
Name:OPAL HOME HEALTH, LLC
Entity Type:Organization
Organization Name:OPAL HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:773-283-3074
Mailing Address - Street 1:4403 W LAWRENCE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2513
Mailing Address - Country:US
Mailing Address - Phone:773-283-3074
Mailing Address - Fax:773-283-2986
Practice Address - Street 1:4403 W LAWRENCE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2513
Practice Address - Country:US
Practice Address - Phone:773-283-3074
Practice Address - Fax:773-283-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011510251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health