Provider Demographics
NPI:1891218574
Name:MAXMATH TUTORING ONLINE INC., ILLINOIS BRANCH
Entity Type:Organization
Organization Name:MAXMATH TUTORING ONLINE INC., ILLINOIS BRANCH
Other - Org Name:MAXMATH HOME HEALTH CARE AGENCY OF ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MAXCENE
Authorized Official - Last Name:DECARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-959-4159
Mailing Address - Street 1:1440 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:888-959-4159
Mailing Address - Fax:888-959-4173
Practice Address - Street 1:1440 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4623
Practice Address - Country:US
Practice Address - Phone:888-959-4159
Practice Address - Fax:888-959-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04685P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04685PMedicaid