Organization
HOME BOUND HEALTHCARE HOSPICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIETA R MITRA (PRESIDENT/SECRETARY/TREASURER)
(630) 914-5140
Entity
Organization
Contact information
Practice address
14216 MCCARTHY RD, LEMONT, IL 60439-9393
(630) 914-5140
(630) 914-5148
Mailing address
14216 MCCARTHY RD, LEMONT, IL 60439-9393
(630) 914-5140
(630) 914-5148
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
2002863
IL
251G00000X
Community Based Hospice Care Agency
PENDING
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072-2002863
ILLINOIS DEPARTMENT OF PUBLIC HEALTH STATE LICENSE
IL
01
—
14D2012259
CLIA ID NUMBER
IL
Enumeration date
06/30/2010
Last updated
03/09/2017
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