Provider Demographics
NPI:1891139820
Name:HARVEST TIME HOME HEALTHCARE INC.
Entity Type:Organization
Organization Name:HARVEST TIME HOME HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:DELLA
Authorized Official - Last Name:HOLLIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-529-7090
Mailing Address - Street 1:5533 W 109TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5046
Mailing Address - Country:US
Mailing Address - Phone:708-529-7090
Mailing Address - Fax:708-529-7547
Practice Address - Street 1:5533 W 109TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5046
Practice Address - Country:US
Practice Address - Phone:708-529-7090
Practice Address - Fax:708-529-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011642251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health