Provider Demographics
NPI:1710958533
Name:HOME BOUND HEALTHCARE, INC.
Entity Type:Organization
Organization Name:HOME BOUND HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:708-798-0800
Mailing Address - Street 1:14216 MCCARTHY RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-9393
Mailing Address - Country:US
Mailing Address - Phone:708-798-0800
Mailing Address - Fax:708-798-0870
Practice Address - Street 1:14216 MCCARTHY RD UNIT A
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-9393
Practice Address - Country:US
Practice Address - Phone:708-798-0800
Practice Address - Fax:708-798-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010413251E00000X
IL1011897251E00000X
14D1036623291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010413OtherHOME HEALTH AGENCY LIC
14D1036623OtherCLIA CERT OF WAIVER
IL1010413OtherHOME HEALTH AGENCY LIC