Provider Demographics
NPI:1841357126
Name:ACACIA HOME HEALTH AGENCY
Entity type:Organization
Organization Name:ACACIA HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT RAYMOND
Authorized Official - Middle Name:BIALA
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-613-8747
Mailing Address - Street 1:2200 S MAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5366
Mailing Address - Country:US
Mailing Address - Phone:630-613-8747
Mailing Address - Fax:630-613-8757
Practice Address - Street 1:2200 S MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5366
Practice Address - Country:US
Practice Address - Phone:630-613-8747
Practice Address - Fax:630-613-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010607251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health