Provider Demographics
NPI:1649246224
Name:PRIVATE HOME CARE UNLIMITED, INC.
Entity type:Organization
Organization Name:PRIVATE HOME CARE UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:800-435-3020
Mailing Address - Street 1:5517 N CUMBERLAND AVE
Mailing Address - Street 2:SUITE 915
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-4738
Mailing Address - Country:US
Mailing Address - Phone:773-467-6000
Mailing Address - Fax:773-467-6001
Practice Address - Street 1:5517 N CUMBERLAND AVE
Practice Address - Street 2:SUITE 915
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-4738
Practice Address - Country:US
Practice Address - Phone:773-467-6000
Practice Address - Fax:773-467-6001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KABAFUSION HOLDING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-24
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1004589251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9639OtherBCBSIL PROVIDER #
IL9639OtherBCBSIL PROVIDER #
IL=========001Medicaid