Provider Demographics
NPI:1255778536
Name:HOME CARE WITH DIGNITY
Entity type:Organization
Organization Name:HOME CARE WITH DIGNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-837-3470
Mailing Address - Street 1:1590 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE #308
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3793
Mailing Address - Country:US
Mailing Address - Phone:847-837-3470
Mailing Address - Fax:847-837-3471
Practice Address - Street 1:930 BURRIDGE ST
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2501
Practice Address - Country:US
Practice Address - Phone:847-837-3470
Practice Address - Fax:847-837-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000757253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care