Provider Demographics
NPI:1619687175
Name:PHYSICIANS HOME CARE LLC
Entity Type:Organization
Organization Name:PHYSICIANS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYROSE
Authorized Official - Middle Name:TAMORO
Authorized Official - Last Name:LAZATIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-871-6674
Mailing Address - Street 1:2100 MANCHESTER RD STE C-1611
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4579
Mailing Address - Country:US
Mailing Address - Phone:331-871-6674
Mailing Address - Fax:630-914-8814
Practice Address - Street 1:2100 MANCHESTER RD STE C-1611
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4579
Practice Address - Country:US
Practice Address - Phone:331-871-6674
Practice Address - Fax:630-914-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-24
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty