Provider Demographics
NPI:1851698203
Name:BOLINGBROOK HOME HEALTH LLC
Entity Type:Organization
Organization Name:BOLINGBROOK HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:TINGEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-378-9997
Mailing Address - Street 1:217 CHRISTINE WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6138
Mailing Address - Country:US
Mailing Address - Phone:630-378-9997
Mailing Address - Fax:
Practice Address - Street 1:217 CHRISTINE WAY
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-6138
Practice Address - Country:US
Practice Address - Phone:630-378-9997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011304251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health