Provider Demographics
NPI:1629259197
Name:STATE HOME HEALTH AGENCY, LTD.
Entity Type:Organization
Organization Name:STATE HOME HEALTH AGENCY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TASNEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-320-1400
Mailing Address - Street 1:17W727 BUTTERFIELD RD
Mailing Address - Street 2:SUITE F & G
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4278
Mailing Address - Country:US
Mailing Address - Phone:630-320-1400
Mailing Address - Fax:630-320-1401
Practice Address - Street 1:17W727 BUTTERFIELD RD
Practice Address - Street 2:SUITE F & G
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4278
Practice Address - Country:US
Practice Address - Phone:630-320-1400
Practice Address - Fax:630-320-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
148062Medicare Oscar/Certification