Provider Demographics
NPI:1598204299
Name:3 CROSS HOME CARE CORP
Entity Type:Organization
Organization Name:3 CROSS HOME CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:CONDE
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-780-2702
Mailing Address - Street 1:544 ONWENTSIA AVE
Mailing Address - Street 2:2F
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2028
Mailing Address - Country:US
Mailing Address - Phone:847-780-2702
Mailing Address - Fax:
Practice Address - Street 1:544 ONWENTSIA AVE
Practice Address - Street 2:2F
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2028
Practice Address - Country:US
Practice Address - Phone:847-780-2702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001310253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care