Provider Demographics
NPI:1528385648
Name:PROHEALTH HOMECARE AGENCY INC
Entity Type:Organization
Organization Name:PROHEALTH HOMECARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:SR
Authorized Official - Credentials:RN
Authorized Official - Phone:630-424-9493
Mailing Address - Street 1:15132 S SUMMIT AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3942
Mailing Address - Country:US
Mailing Address - Phone:630-424-9498
Mailing Address - Fax:630-424-3488
Practice Address - Street 1:15132 S SUMMIT AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3942
Practice Address - Country:US
Practice Address - Phone:630-424-9498
Practice Address - Fax:630-424-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
IL1011353251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health