Provider Demographics
NPI:1417189838
Name:WHOLE LIFE HOME HEALTH LLC
Entity Type:Organization
Organization Name:WHOLE LIFE HOME HEALTH LLC
Other - Org Name:WHOLE LIFE HOME HEALTH, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:CHACKO
Authorized Official - Last Name:KOCHUPARAMBIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-588-2111
Mailing Address - Street 1:2860 S RIVER RD STE 270
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-6002
Mailing Address - Country:US
Mailing Address - Phone:847-588-2111
Mailing Address - Fax:847-588-1147
Practice Address - Street 1:2860 S RIVER RD STE 270
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-6002
Practice Address - Country:US
Practice Address - Phone:847-588-2111
Practice Address - Fax:847-588-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011053251E00000X
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-8317Medicare UPIN