Provider Demographics
NPI:1558447920
Name:EMMANUEL HOME HEALTH, INC.
Entity Type:Organization
Organization Name:EMMANUEL HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-658-3980
Mailing Address - Street 1:610 LAKE PLUMLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5018
Mailing Address - Country:US
Mailing Address - Phone:847-658-3980
Mailing Address - Fax:847-658-6093
Practice Address - Street 1:610 LAKE PLUMLEIGH WAY
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5018
Practice Address - Country:US
Practice Address - Phone:847-658-3980
Practice Address - Fax:847-658-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010621251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010621OtherIDPH LICENSE