Provider Demographics
NPI:1275940348
Name:NORTHWEST HOME CARE, INC.
Entity Type:Organization
Organization Name:NORTHWEST HOME CARE, INC.
Other - Org Name:ABCOR HOME HEALTH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-670-8424
Mailing Address - Street 1:1437 S. BELL SCHOOL ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108
Mailing Address - Country:US
Mailing Address - Phone:815-986-9606
Mailing Address - Fax:815-986-2082
Practice Address - Street 1:1437 S. BELL SCHOOL ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108
Practice Address - Country:US
Practice Address - Phone:815-986-9606
Practice Address - Fax:815-986-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011043251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148229OtherMEDICARE PTAN
IL148229OtherMEDICARE PTAN