Provider Demographics
NPI:1598808123
Name:MOTHER BABY HOMECARE, INC.
Entity Type:Organization
Organization Name:MOTHER BABY HOMECARE, INC.
Other - Org Name:MATERNA WELLBORN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PERRONE
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:847-458-9823
Mailing Address - Street 1:306 RUSTIC LN
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3233
Mailing Address - Country:US
Mailing Address - Phone:847-745-8982
Mailing Address - Fax:847-658-1088
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2637
Practice Address - Country:US
Practice Address - Phone:847-458-9823
Practice Address - Fax:847-658-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty