Provider Demographics
NPI:1124388087
Name:GEORGETOWN HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:GEORGETOWN HOME HEALTH CARE INC
Other - Org Name:GEORGETOWN HOME HEALTH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOPELOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBOJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-678-9772
Mailing Address - Street 1:1700 E ALGONQUIN RD
Mailing Address - Street 2:STE 106
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9632
Mailing Address - Country:US
Mailing Address - Phone:224-678-9772
Mailing Address - Fax:224-333-0496
Practice Address - Street 1:1700 E ALGONQUIN RD
Practice Address - Street 2:STE 106
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9632
Practice Address - Country:US
Practice Address - Phone:224-678-9772
Practice Address - Fax:224-333-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011506OtherILLINOIS DEPT. OF PUBLIC HEALTH