Organization
OPEN WATERS HOME HEALTH CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEODELFIN C DY (ADMINISTRATOR/PRESIDENT)
(847) 329-8585
Entity
Organization
Contact information
Practice address
5940 W TOUHY AVENUE, SUITE #145, NILES, IL 60714-4613
(847) 329-8585
(847) 329-8181
Mailing address
5940 W TOUHY AVENUE, SUITE #145, NILES, IL 60714-4613
(847) 329-8585
(847) 329-8181
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010778
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010778
DEPT. OF PUBLIC HEALTH
IL
01
—
14D1069867
CLIA
IL
Enumeration date
12/04/2007
Last updated
10/24/2019
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