Provider Demographics
NPI:1225182280
Name:PRO VITA HOME CARE, LLC.
Entity Type:Organization
Organization Name:PRO VITA HOME CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RODEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGAYONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-275-2190
Mailing Address - Street 1:5875 N LINCOLN AVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4668
Mailing Address - Country:US
Mailing Address - Phone:773-275-2190
Mailing Address - Fax:773-275-2195
Practice Address - Street 1:5875 N LINCOLN AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4668
Practice Address - Country:US
Practice Address - Phone:773-275-2190
Practice Address - Fax:773-275-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010672251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health