1417189838 NPI number — WHOLE LIFE HOME HEALTH LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417189838 NPI number — WHOLE LIFE HOME HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHOLE LIFE HOME HEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WHOLE LIFE HOME HEALTH, INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417189838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2860 S RIVER RD STE 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60018-6002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-588-2111
Provider Business Mailing Address Fax Number:
847-588-1147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2860 S RIVER RD STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES PLAINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60018-6002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-588-2111
Provider Business Practice Location Address Fax Number:
847-588-1147
Provider Enumeration Date:
08/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KOCHUPARAMBIL
Authorized Official First Name:
TONY
Authorized Official Middle Name:
CHACKO
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
847-588-2111

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1011053 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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