Provider Demographics
NPI:1912929845
Name:ST THOMAS HEALTH CARE INC
Entity Type:Organization
Organization Name:ST THOMAS HEALTH CARE INC
Other - Org Name:WAILAI HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-895-2951
Mailing Address - Street 1:4554 N BROADWAY ST STE 312
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5621
Mailing Address - Country:US
Mailing Address - Phone:773-769-2820
Mailing Address - Fax:773-271-3678
Practice Address - Street 1:4554 N BROADWAY ST STE 312
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5621
Practice Address - Country:US
Practice Address - Phone:773-769-2820
Practice Address - Fax:773-271-3678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST THOMAS HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-23
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147840Medicare ID - Type UnspecifiedPROVIDER NUMBER