Provider Demographics
NPI:1275738502
Name:HEXAGRAM HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:HEXAGRAM HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:EMBRADURA
Authorized Official - Last Name:TUANQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-205-1416
Mailing Address - Street 1:4747 W PETERSON AVE
Mailing Address - Street 2:410
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5712
Mailing Address - Country:US
Mailing Address - Phone:773-205-1416
Mailing Address - Fax:773-557-7048
Practice Address - Street 1:4747 W PETERSON AVE
Practice Address - Street 2:410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5712
Practice Address - Country:US
Practice Address - Phone:773-205-1416
Practice Address - Fax:773-557-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010712251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health