Provider Demographics
NPI:1588649552
Name:RESPITE CARE/CARE IN THE HOME, INC.
Entity Type:Organization
Organization Name:RESPITE CARE/CARE IN THE HOME, INC.
Other - Org Name:CARE IN THE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:847-256-1705
Mailing Address - Street 1:1200 CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2654
Mailing Address - Country:US
Mailing Address - Phone:847-256-1705
Mailing Address - Fax:847-256-1770
Practice Address - Street 1:1200 CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2654
Practice Address - Country:US
Practice Address - Phone:847-256-1705
Practice Address - Fax:847-256-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X, 251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
147719Medicare ID - Type Unspecified