Provider Demographics
NPI:1285198523
Name:SUGAR HOME HEALTH LLC
Entity Type:Organization
Organization Name:SUGAR HOME HEALTH LLC
Other - Org Name:SUGAR HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-828-3093
Mailing Address - Street 1:600 HOLIDAY PLAZA DR STE 182
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2236
Mailing Address - Country:US
Mailing Address - Phone:312-924-1831
Mailing Address - Fax:312-924-1832
Practice Address - Street 1:600 HOLIDAY PLAZA DR STE 182
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2236
Practice Address - Country:US
Practice Address - Phone:312-924-1831
Practice Address - Fax:312-924-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3002055OtherSTATE LICENSE/ HOME SERVICE AGENCY
IL14D2251718OtherCLIA LAB
IL4000710OtherSTATE LICENSE/ HOME NURSING AGENCY