Provider Demographics
NPI:1326109448
Name:CHICAGOLAND HOME HEALTH PROVIDER, INC.
Entity Type:Organization
Organization Name:CHICAGOLAND HOME HEALTH PROVIDER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAPLALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-296-3950
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-296-3950
Mailing Address - Fax:847-296-3955
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE 508
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-296-3950
Practice Address - Fax:847-296-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1677304251E00000X
IL101104251E00000X
IL1010421251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147854Medicare UPIN