Provider Demographics
NPI:1568556793
Name:CHALICE HOME HEALTH CARE
Entity Type:Organization
Organization Name:CHALICE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGILIO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-622-7140
Mailing Address - Street 1:7136 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2805
Mailing Address - Country:US
Mailing Address - Phone:773-622-7140
Mailing Address - Fax:773-622-7442
Practice Address - Street 1:7136 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-2805
Practice Address - Country:US
Practice Address - Phone:773-622-7140
Practice Address - Fax:773-622-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147787251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147787Medicare Oscar/Certification
IL147787Medicare PIN