Provider Demographics
NPI:1669521654
Name:MIDWEST PEARL HOME HEALTHCARE INC
Entity type:Organization
Organization Name:MIDWEST PEARL HOME HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:NELVA
Authorized Official - Middle Name:DURAN
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-237-2655
Mailing Address - Street 1:1925 N HARLEM AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3743
Mailing Address - Country:US
Mailing Address - Phone:773-237-2655
Mailing Address - Fax:773-237-2717
Practice Address - Street 1:1925 N HARLEM AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3743
Practice Address - Country:US
Practice Address - Phone:773-237-2655
Practice Address - Fax:773-237-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1010485251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147882Medicare Oscar/Certification