Provider Demographics
NPI:1689878035
Name:ADMIRAL HOME HEALTH INC.
Entity Type:Organization
Organization Name:ADMIRAL HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZCONA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-410-8750
Mailing Address - Street 1:2504 WASHINGTON ST
Mailing Address - Street 2:SUITE 201-5
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4983
Mailing Address - Country:US
Mailing Address - Phone:847-410-8750
Mailing Address - Fax:847-655-2709
Practice Address - Street 1:2504 WASHINGTON ST
Practice Address - Street 2:SUITE 201-5
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4983
Practice Address - Country:US
Practice Address - Phone:847-410-8750
Practice Address - Fax:847-655-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010623251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010623OtherSTATE LICENCE