Provider Demographics
NPI:1265724066
Name:GOODHOPE HEALTHCARE AND HOME HEALTH SERVICES INC
Entity type:Organization
Organization Name:GOODHOPE HEALTHCARE AND HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIMATARA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBIRIM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:815-788-7190
Mailing Address - Street 1:3631 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5434
Mailing Address - Country:US
Mailing Address - Phone:815-788-7190
Mailing Address - Fax:800-884-1732
Practice Address - Street 1:3631 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5434
Practice Address - Country:US
Practice Address - Phone:815-788-7190
Practice Address - Fax:800-884-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174200000X, 251G00000X, 251J00000X, 261QA0600X, 385H00000X, 376J00000X
IL1011393251E00000X
IL4000326251J00000X
IL3000707253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148288Medicare Oscar/Certification