Provider Demographics
NPI:1619158011
Name:DINAMIC HEALTH CARE, LLC
Entity Type:Organization
Organization Name:DINAMIC HEALTH CARE, LLC
Other - Org Name:DINAMIC HEALTH CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-983-4623
Mailing Address - Street 1:353 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-2555
Mailing Address - Country:US
Mailing Address - Phone:708-832-9908
Mailing Address - Fax:708-832-9935
Practice Address - Street 1:353 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2555
Practice Address - Country:US
Practice Address - Phone:708-832-9908
Practice Address - Fax:708-832-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010797251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-8040Medicare PIN