Provider Demographics
NPI:1497991418
Name:ANJUMOHSI, INC
Entity Type:Organization
Organization Name:ANJUMOHSI, INC
Other - Org Name:ASTRA HEALTH WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWINE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-206-6852
Mailing Address - Street 1:1707 N RANDALL RD STE 165
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9410
Mailing Address - Country:US
Mailing Address - Phone:847-583-8998
Mailing Address - Fax:847-583-8999
Practice Address - Street 1:1707 N RANDALL RD STE 165
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9410
Practice Address - Country:US
Practice Address - Phone:847-583-8998
Practice Address - Fax:847-583-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010992251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health