Provider Demographics
NPI:1578533246
Name:PRESBYTERIAN HOME
Entity Type:Organization
Organization Name:PRESBYTERIAN HOME
Other - Org Name:HOME HEALTH AGENCY OF PRESBYTERIAN HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANDSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-492-4859
Mailing Address - Street 1:3200 GRANT STREET
Mailing Address - Street 2:ACCOUNTING DEPARTMENT
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-492-4871
Mailing Address - Fax:847-570-3426
Practice Address - Street 1:3200 GRANT STREET
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-492-4800
Practice Address - Fax:847-570-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1008861251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147647Medicare Oscar/Certification