Provider Demographics
NPI:1255581203
Name:PHYSICIAN PREFERRED HOME CARE INC.
Entity type:Organization
Organization Name:PHYSICIAN PREFERRED HOME CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-500-3895
Mailing Address - Street 1:7670 PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5607
Mailing Address - Country:US
Mailing Address - Phone:312-500-3895
Mailing Address - Fax:312-584-1331
Practice Address - Street 1:7670 PLAZA CT
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5607
Practice Address - Country:US
Practice Address - Phone:312-500-3895
Practice Address - Fax:312-584-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1011068251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148228Medicare Oscar/Certification