Provider Demographics
NPI:1740430826
Name:HOMELAND HOMEHEALTH PROVIDER, INC,
Entity Type:Organization
Organization Name:HOMELAND HOMEHEALTH PROVIDER, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WARDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-493-9328
Mailing Address - Street 1:8031 N MILWAUKEE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2827
Mailing Address - Country:US
Mailing Address - Phone:847-983-4364
Mailing Address - Fax:847-983-4157
Practice Address - Street 1:8031 N MILWAUKEE AVE FL 2
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2827
Practice Address - Country:US
Practice Address - Phone:847-410-2851
Practice Address - Fax:847-410-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011931251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011931OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH