Provider Demographics
NPI:1861652612
Name:MSMC HOME CARE LLC
Entity Type:Organization
Organization Name:MSMC HOME CARE LLC
Other - Org Name:METROSOUTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-824-4412
Mailing Address - Street 1:12935 SOUTH GREGORY STREET
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2428
Mailing Address - Country:US
Mailing Address - Phone:798-371-7777
Mailing Address - Fax:708-371-7628
Practice Address - Street 1:12935 SOUTH GREGORY STREET
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:798-371-7777
Practice Address - Fax:708-371-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
14-7405BMedicare UPIN