Provider Demographics
NPI:1528414299
Name:HOME SWEET HOME CARE LLC
Entity Type:Organization
Organization Name:HOME SWEET HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KORDICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-469-7117
Mailing Address - Street 1:72 S LA GRANGE RD
Mailing Address - Street 2:STE. 5
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2475
Mailing Address - Country:US
Mailing Address - Phone:708-469-7117
Mailing Address - Fax:
Practice Address - Street 1:72 S LA GRANGE RD
Practice Address - Street 2:STE. 5
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2475
Practice Address - Country:US
Practice Address - Phone:708-469-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000130253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care