Provider Demographics
NPI:1720476161
Name:MLM HOMECARE
Entity Type:Organization
Organization Name:MLM HOMECARE
Other - Org Name:VISITING ANGELS LIBERTYVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-996-0888
Mailing Address - Street 1:14048 W PETRONELLA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-9699
Mailing Address - Country:US
Mailing Address - Phone:847-996-0888
Mailing Address - Fax:847-996-0899
Practice Address - Street 1:14048 W PETRONELLA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9699
Practice Address - Country:US
Practice Address - Phone:847-996-0888
Practice Address - Fax:847-996-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000144253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care