Provider Demographics
NPI:1437937232
Name:CHICAGO ELITE HOME CARE PROVIDER, LLC
Entity Type:Organization
Organization Name:CHICAGO ELITE HOME CARE PROVIDER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLONGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-300-1001
Mailing Address - Street 1:7808 W COLLEGE DR STE LL1
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1027
Mailing Address - Country:US
Mailing Address - Phone:708-300-1001
Mailing Address - Fax:
Practice Address - Street 1:7808 W COLLEGE DR STE LL1
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1027
Practice Address - Country:US
Practice Address - Phone:708-300-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care