Provider Demographics
NPI:1336454164
Name:HOLY MARY HOMEHEALTH CARE INC
Entity Type:Organization
Organization Name:HOLY MARY HOMEHEALTH CARE INC
Other - Org Name:CAREDIEM HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAJOO
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, MHI
Authorized Official - Phone:708-867-8405
Mailing Address - Street 1:1540 E DUNDEE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-8316
Mailing Address - Country:US
Mailing Address - Phone:708-867-8405
Mailing Address - Fax:708-867-8406
Practice Address - Street 1:1540 E DUNDEE RD STE 108
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-8316
Practice Address - Country:US
Practice Address - Phone:708-867-8405
Practice Address - Fax:708-867-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011281251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGOtherMEDICARE ID-TYPE UNSPECIFIED