Provider Demographics
NPI:1417962812
Name:P.W. HOME HEALTH INC
Entity Type:Organization
Organization Name:P.W. HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-565-4170
Mailing Address - Street 1:17W662 BUTTERFIELD RD STE 306
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4006
Mailing Address - Country:US
Mailing Address - Phone:847-565-4170
Mailing Address - Fax:847-565-4173
Practice Address - Street 1:17W662 BUTTERFIELD RD STE 306
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4006
Practice Address - Country:US
Practice Address - Phone:847-565-4170
Practice Address - Fax:847-565-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147832Medicare ID - Type Unspecified
IL=========001Medicaid