Provider Demographics
NPI:1013276583
Name:AGAPE HOME HEALTH OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:AGAPE HOME HEALTH OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILUMINADA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:312-203-5235
Mailing Address - Street 1:400 TWIN CREEKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1078
Mailing Address - Country:US
Mailing Address - Phone:630-985-0550
Mailing Address - Fax:630-985-0660
Practice Address - Street 1:400 TWIN CREEKS DRIVE
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60640-1040
Practice Address - Country:US
Practice Address - Phone:630-985-0550
Practice Address - Fax:630-985-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health