Provider Demographics
NPI:1609825678
Name:COMMUNITY ALLIANCE HOME HEALTH
Entity Type:Organization
Organization Name:COMMUNITY ALLIANCE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-665-7000
Mailing Address - Street 1:ONE MERCHANTS PLAZA
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9453
Mailing Address - Country:US
Mailing Address - Phone:630-933-7851
Mailing Address - Fax:630-933-7852
Practice Address - Street 1:ONE MERCHANTS PLAZA
Practice Address - Street 2:SUITE 202
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9453
Practice Address - Country:US
Practice Address - Phone:630-933-7851
Practice Address - Fax:630-933-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010207251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
50111OtherBCBS PROVIDER #.
IL3000465335001Medicaid
IL3000465335001Medicaid