Provider Demographics
NPI:1972533735
Name:HARMONY HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:HARMONY HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FLORENCIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:GERONIMO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:708-274-4420
Mailing Address - Street 1:245 W ROOSEVELT RD BLDG 130-131
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3739
Mailing Address - Country:US
Mailing Address - Phone:708-274-4420
Mailing Address - Fax:708-274-4427
Practice Address - Street 1:245 W ROOSEVELT RD # 130-131
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3739
Practice Address - Country:US
Practice Address - Phone:708-274-4420
Practice Address - Fax:708-274-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010530251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D1044975OtherCMS- CLIA CERT. OF WAIVER
IL1972533735OtherNPPES
IL147929OtherMEDICARE PROVIDER NUMBER
IL1010530OtherIDPH LICENSE NUMBER