Provider Demographics
NPI:1265653927
Name:LOYOLA HOME HEALTHCARE RESPURCES INC
Entity Type:Organization
Organization Name:LOYOLA HOME HEALTHCARE RESPURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIOSCORO
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-234-3743
Mailing Address - Street 1:5007 LINCOLN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4187
Mailing Address - Country:US
Mailing Address - Phone:630-322-9600
Mailing Address - Fax:
Practice Address - Street 1:5007 LINCOLN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4187
Practice Address - Country:US
Practice Address - Phone:630-322-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1809048251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147796Medicare ID - Type UnspecifiedPROVIDER NUMBER