Provider Demographics
NPI:1952553133
Name:HOME BOUND HEALTHCARE, INC.
Entity type:Organization
Organization Name:HOME BOUND HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALIWODA
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:815-895-9898
Mailing Address - Street 1:1740 MEDITERRANEAN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3143
Mailing Address - Country:US
Mailing Address - Phone:815-895-9898
Mailing Address - Fax:815-985-3232
Practice Address - Street 1:1740 MEDITERRANEAN DR STE 101
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3143
Practice Address - Country:US
Practice Address - Phone:815-895-9898
Practice Address - Fax:815-985-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010949251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D1091029OtherCLIA CERTIFICATE WAIVER