Provider Demographics
NPI:1013928357
Name:PHOENIX HOME CARE, L.L.C.
Entity Type:Organization
Organization Name:PHOENIX HOME CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOVI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-321-9400
Mailing Address - Street 1:15W700 N FRONTAGE RD STE 136
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7504
Mailing Address - Country:US
Mailing Address - Phone:630-321-9400
Mailing Address - Fax:630-654-5705
Practice Address - Street 1:15W700 N FRONTAGE RD STE 136
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7504
Practice Address - Country:US
Practice Address - Phone:630-921-9400
Practice Address - Fax:630-654-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4518860001Medicaid
IL50351OtherBLUE CROSS/BLUE SHIELD
IL147730Medicare PIN