Provider Demographics
NPI:1982886974
Name:GERIACARE HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:GERIACARE HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/AGENCY SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:BONGON
Authorized Official - Last Name:SIAPNO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:630-620-9305
Mailing Address - Street 1:450 E 22ND ST
Mailing Address - Street 2:SUITE 172
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6113
Mailing Address - Country:US
Mailing Address - Phone:630-620-9305
Mailing Address - Fax:630-216-1150
Practice Address - Street 1:450 E 22ND ST
Practice Address - Street 2:SUITE 172
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6113
Practice Address - Country:US
Practice Address - Phone:630-620-9305
Practice Address - Fax:630-216-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010750251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health