Provider Demographics
NPI:1518182708
Name:INSTITUTE OF MEDICAL PROFESSIONALS
Entity Type:Organization
Organization Name:INSTITUTE OF MEDICAL PROFESSIONALS
Other - Org Name:CARE OPTIONS AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FERNANDES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-616-0102
Mailing Address - Street 1:221 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2608
Mailing Address - Country:US
Mailing Address - Phone:708-763-9720
Mailing Address - Fax:708-406-1549
Practice Address - Street 1:221 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2608
Practice Address - Country:US
Practice Address - Phone:708-763-9720
Practice Address - Fax:708-406-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147986Medicare Oscar/Certification