Provider Demographics
NPI:1558300335
Name:NEIGHBORHOOD HEALTH CARE, LLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR LLC MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-229-0723
Mailing Address - Street 1:6253 W 95TH ST
Mailing Address - Street 2:SUITE 2S
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2762
Mailing Address - Country:US
Mailing Address - Phone:708-229-0723
Mailing Address - Fax:708-229-2846
Practice Address - Street 1:6253 W 95TH ST
Practice Address - Street 2:SUITE 2S
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2762
Practice Address - Country:US
Practice Address - Phone:708-229-0723
Practice Address - Fax:708-229-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147728Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER