Organization
DIVINE PROVIDENCE HOME HEALTH AGENCY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARNOLD JAY DONATO (CHIEF FINANCIAL OFFICER)
(773) 433-3320
Entity
Organization
Contact information
Practice address
3550 W PETERSON AVE, SUITE 304, CHICAGO, IL 60659-3270
(773) 433-3320
(773) 433-3329
Mailing address
3550 W PETERSON AVE, SUITE 304, CHICAGO, IL 60659-3270
(773) 433-3320
(773) 433-3329
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010341
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010341
HOME HEALTH LICENSE
IL
Enumeration date
09/20/2006
Last updated
10/05/2012
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