Provider Demographics
NPI:1144411562
Name:CHICAGO MIDWEST HOME HEALTH INC.
Entity type:Organization
Organization Name:CHICAGO MIDWEST HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETORY
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:RAZZAQ
Authorized Official - Last Name:SIDDIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-890-3275
Mailing Address - Street 1:2454 E DEMPSTER ST STE 151
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5315
Mailing Address - Country:US
Mailing Address - Phone:847-784-9966
Mailing Address - Fax:847-305-3002
Practice Address - Street 1:2454 E DEMPSTER ST STE 151
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5315
Practice Address - Country:US
Practice Address - Phone:847-784-9966
Practice Address - Fax:847-305-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010677251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148063OtherMEDICARE PTAN
IL1010677OtherILLINOIS STATE LICENSE