Provider Demographics
NPI:1902863061
Name:GOLDEN HEART HOME HEALTH INC.
Entity Type:Organization
Organization Name:GOLDEN HEART HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMIBAO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:847-759-8970
Mailing Address - Street 1:10700 W HIGGINS RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-3707
Mailing Address - Country:US
Mailing Address - Phone:847-759-8970
Mailing Address - Fax:847-759-8975
Practice Address - Street 1:10700 W HIGGINS RD
Practice Address - Street 2:SUITE 340
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-3707
Practice Address - Country:US
Practice Address - Phone:847-759-8970
Practice Address - Fax:847-759-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1010169251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001010169Medicaid
ILIL1010169OtherSTATE LICENSE
IL001010169Medicaid