Provider Demographics
NPI:1538241831
Name:NORTHWEST HOME HEALTH CARE & REHABILITATION, INC.
Entity type:Organization
Organization Name:NORTHWEST HOME HEALTH CARE & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PARDIKES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:847-854-0186
Mailing Address - Street 1:9249 SOUTH ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-1670
Mailing Address - Country:US
Mailing Address - Phone:847-854-0186
Mailing Address - Fax:847-854-0213
Practice Address - Street 1:9249 SOUTH ROUTE 31
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-1670
Practice Address - Country:US
Practice Address - Phone:847-854-0186
Practice Address - Fax:847-854-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010425251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50439OtherBCBS PROVIDER
IL147824Medicare ID - Type UnspecifiedPROVIDER