Provider Demographics
NPI:1346348851
Name:ST. RITA HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ST. RITA HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:BUENDIA
Authorized Official - Last Name:AGATEP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-378-8330
Mailing Address - Street 1:5105 TOLLVIEW DR.
Mailing Address - Street 2:STE. 101
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3725
Mailing Address - Country:US
Mailing Address - Phone:847-378-8330
Mailing Address - Fax:847-378-8337
Practice Address - Street 1:5105 TOLLVIEW DR.
Practice Address - Street 2:STE. 101
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3725
Practice Address - Country:US
Practice Address - Phone:847-378-8330
Practice Address - Fax:847-378-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010618251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147955Medicare PIN