Provider Demographics
NPI:1659041051
Name:PHAD HOME CARE INC
Entity Type:Organization
Organization Name:PHAD HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEACE
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-858-8337
Mailing Address - Street 1:7077 N ASHLAND BLVD RM 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2724
Mailing Address - Country:US
Mailing Address - Phone:414-858-8337
Mailing Address - Fax:
Practice Address - Street 1:7077 N ASHLAND BLVD RM 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2724
Practice Address - Country:US
Practice Address - Phone:414-858-8337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care