Organization
EBENEZER HOME HEALTH SERVICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILOU VILLASENOR (PRESIDENT)
(773) 793-8627
Entity
Organization
Contact information
Practice address
16860 OAK PARK AVE STE 201C, TINLEY PARK, IL 60477-2787
(708) 444-8511
(708) 570-0800
Mailing address
16860 OAK PARK AVE STE 201C, TINLEY PARK, IL 60477-2787
(708) 444-8511
(708) 444-8514
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010723
DEPT OF PUBLIC HEALTH
IL
05
—
1215075932
—
IL
05
—
1215075932001
—
IL
Enumeration date
02/02/2007
Last updated
07/07/2021
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