Provider Demographics
NPI:1275582108
Name:COMPASSIONATE PROFESSIONAL HOME CARE, INC.
Entity Type:Organization
Organization Name:COMPASSIONATE PROFESSIONAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDEN RACHEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ESPINA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MN
Authorized Official - Phone:708-832-8206
Mailing Address - Street 1:2520 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60633-2258
Mailing Address - Country:US
Mailing Address - Phone:708-832-8206
Mailing Address - Fax:708-832-8208
Practice Address - Street 1:2520 E STATE ST
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:IL
Practice Address - Zip Code:60633-2258
Practice Address - Country:US
Practice Address - Phone:708-832-8206
Practice Address - Fax:708-832-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1685084251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147752Medicaid
IL147752Medicare ID - Type UnspecifiedHOME HEALTH AGENCY