Organization
PHOENIX HOME CARE, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOVI WEILL (ADMINISTRATOR)
(630) 321-9400
Entity
Organization
Contact information
Practice address
15W700 N FRONTAGE RD STE 136, BURR RIDGE, IL 60527-7504
(630) 921-9400
(630) 654-5705
Mailing address
15W700 N FRONTAGE RD STE 136, BURR RIDGE, IL 60527-7504
(630) 321-9400
(630) 654-5705
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010174
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4518860001
—
IL
01
—
50351
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
08/11/2006
Last updated
07/09/2023
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