1902863061 NPI number — GOLDEN HEART HOME HEALTH INC.

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 1902863061 NPI number — GOLDEN HEART HOME HEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN HEART HOME HEALTH INC.
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:
Provider Other Organization Name Type Code:
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:
1902863061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10700 W HIGGINS RD
Provider Second Line Business Mailing Address:
SUITE 340
Provider Business Mailing Address City Name:
ROSEMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60018-3707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-759-8970
Provider Business Mailing Address Fax Number:
847-759-8975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10700 W HIGGINS RD
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
ROSEMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60018-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-759-8970
Provider Business Practice Location Address Fax Number:
847-759-8975
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOMIBAO
Authorized Official First Name:
JESS
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
847-759-8970

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  IL1010169 , 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)

  • Identifier: 001010169 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: IL1010169 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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