Provider Demographics
NPI:1548220932
Name:ELMHURST MEMORIAL HOME HEALTH
Entity Type:Organization
Organization Name:ELMHURST MEMORIAL HOME HEALTH
Other - Org Name:MEMORIAL HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-833-8200
Mailing Address - Street 1:855 N CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1005
Mailing Address - Country:US
Mailing Address - Phone:630-833-8200
Mailing Address - Fax:630-833-9926
Practice Address - Street 1:855 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1005
Practice Address - Country:US
Practice Address - Phone:630-833-8200
Practice Address - Fax:630-833-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2001501251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9539OtherBLUE CROSS
IL9539OtherBLUE CROSS
IL=========02Medicaid