Provider Demographics
NPI:1689625857
Name:FORUM HEALTH CARE INC
Entity Type:Organization
Organization Name:FORUM HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOMUTOV
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-897-9090
Mailing Address - Street 1:900 SKOKIE BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4012
Mailing Address - Country:US
Mailing Address - Phone:847-897-9090
Mailing Address - Fax:847-897-9090
Practice Address - Street 1:900 SKOKIE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4012
Practice Address - Country:US
Practice Address - Phone:847-897-9090
Practice Address - Fax:847-897-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010521251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147898Medicare Oscar/Certification