Provider Demographics
NPI:1982602207
Name:PREMIER HOMECARE SUPPLIES, LTD
Entity Type:Organization
Organization Name:PREMIER HOMECARE SUPPLIES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-776-9941
Mailing Address - Street 1:8048 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-2603
Mailing Address - Country:US
Mailing Address - Phone:773-776-9941
Mailing Address - Fax:773-776-9953
Practice Address - Street 1:8048 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-2603
Practice Address - Country:US
Practice Address - Phone:773-776-9941
Practice Address - Fax:773-776-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5778332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL1107610001Medicare NSC