Provider Demographics
NPI:1568739597
Name:MEDWEST HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MEDWEST HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-287-7954
Mailing Address - Street 1:3300 N CARRIAGEWAY DR
Mailing Address - Street 2:UNIT 211
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1554
Mailing Address - Country:US
Mailing Address - Phone:847-287-7954
Mailing Address - Fax:847-626-9631
Practice Address - Street 1:3300 N CARRIAGEWAY DR
Practice Address - Street 2:UNIT 211
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1554
Practice Address - Country:US
Practice Address - Phone:847-287-7954
Practice Address - Fax:847-626-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011464251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health