Provider Demographics
NPI:1497701403
Name:ASPEN HOME HEALTH, MEDICAL & REHABILITATION SERVICE, INCORPORATED
Entity Type:Organization
Organization Name:ASPEN HOME HEALTH, MEDICAL & REHABILITATION SERVICE, INCORPORATED
Other - Org Name:ASPEN HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR OF NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:IOAN
Authorized Official - Last Name:PINTEA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-685-7338
Mailing Address - Street 1:5244 W IRVING PARK RD
Mailing Address - Street 2:# 1 WEST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2596
Mailing Address - Country:US
Mailing Address - Phone:773-685-7338
Mailing Address - Fax:773-685-3181
Practice Address - Street 1:5244 W IRVING PARK RD
Practice Address - Street 2:# 1 WEST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2596
Practice Address - Country:US
Practice Address - Phone:773-685-7338
Practice Address - Fax:773-685-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010580251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147923Medicare ID - Type UnspecifiedHOME HEALTH SERVICES