Provider Demographics
NPI:1487654356
Name:ORACLE HEALTHCARE INC
Entity Type:Organization
Organization Name:ORACLE HEALTHCARE INC
Other - Org Name:ABC HEALTHCARE, INC. DBA ANREX HEALTH CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:RAZZAQ
Authorized Official - Last Name:SIDDIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-813-5827
Mailing Address - Street 1:2604 DEMPSTER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8426
Mailing Address - Country:US
Mailing Address - Phone:224-470-5130
Mailing Address - Fax:630-230-4630
Practice Address - Street 1:2604 DEMPSTER ST STE 202
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8426
Practice Address - Country:US
Practice Address - Phone:224-470-5130
Practice Address - Fax:630-230-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1571762251E00000X
IL1011810251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147561Medicare UPIN