Provider Demographics
NPI:1497848949
Name:CELESTIAL HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:CELESTIAL HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-625-3326
Mailing Address - Street 1:3559 N CUMBERLAND AVE.
Mailing Address - Street 2:SUITE 106/107
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2865
Mailing Address - Country:US
Mailing Address - Phone:773-625-3326
Mailing Address - Fax:773-625-1948
Practice Address - Street 1:3559 N CUMBERLAND AVE
Practice Address - Street 2:SUITE 106/107
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2865
Practice Address - Country:US
Practice Address - Phone:773-625-3326
Practice Address - Fax:773-625-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1010389251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-7861OtherMEDICARE
IL14-7861Medicare PIN