Provider Demographics
NPI:1013927318
Name:PROHEALTH HOMECARE LLC
Entity Type:Organization
Organization Name:PROHEALTH HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/AGENCY SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAZHAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:TABREZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-795-0800
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:STE#205
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-795-0800
Mailing Address - Fax:847-795-0808
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:STE#205
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-795-0800
Practice Address - Fax:847-795-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010403163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
147934Medicare Oscar/Certification