Provider Demographics
NPI:1265686539
Name:HOME BOUND HEALTHCARE OUTPATIENT THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:HOME BOUND HEALTHCARE OUTPATIENT THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-863-7881
Mailing Address - Street 1:14200 MCCARTHY RD
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-9393
Mailing Address - Country:US
Mailing Address - Phone:847-288-1650
Mailing Address - Fax:847-288-1660
Practice Address - Street 1:14200 MCCARTHY RD
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-9393
Practice Address - Country:US
Practice Address - Phone:847-288-1650
Practice Address - Fax:847-288-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7724Medicare Oscar/Certification