Provider Demographics
NPI:1457360059
Name:SURE CARE HOME HEALTH,CORP.
Entity Type:Organization
Organization Name:SURE CARE HOME HEALTH,CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZOSIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTUELLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:1866-765-1197
Mailing Address - Street 1:1155 N MAIN ST
Mailing Address - Street 2:SUITE C & D
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3508
Mailing Address - Country:US
Mailing Address - Phone:186-676-5119
Mailing Address - Fax:847-805-9832
Practice Address - Street 1:1155 N MAIN ST
Practice Address - Street 2:SUITE C & D
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3508
Practice Address - Country:US
Practice Address - Phone:186-676-5119
Practice Address - Fax:847-805-9832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURE CARE HOME HEALTH,CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010375251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147810Medicare ID - Type UnspecifiedHOME HEALTH