Provider Demographics
NPI:1356388219
Name:CHICAGO HOME HEALTHCARE, S.C.
Entity type:Organization
Organization Name:CHICAGO HOME HEALTHCARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-421-6800
Mailing Address - Street 1:940 W ADAMS ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3752
Mailing Address - Country:US
Mailing Address - Phone:630-450-0189
Mailing Address - Fax:312-421-5366
Practice Address - Street 1:940 W ADAMS ST STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3752
Practice Address - Country:US
Practice Address - Phone:312-421-6800
Practice Address - Fax:312-421-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
ILIL1010429251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1010429OtherHOME HEALTH LICENSE NO.
ILMW11950OtherSUBMITTER ID
IL147826Medicaid