Provider Demographics
NPI:1538576608
Name:NORTHWEST HOME CARE, INC.
Entity type:Organization
Organization Name:NORTHWEST HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KULBACHNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-670-8268
Mailing Address - Street 1:2525 CABOT DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3627
Mailing Address - Country:US
Mailing Address - Phone:630-687-9050
Mailing Address - Fax:630-658-7358
Practice Address - Street 1:2525 CABOT DR STE 103
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3627
Practice Address - Country:US
Practice Address - Phone:630-687-9050
Practice Address - Fax:630-658-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011043251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011043OtherHOME HEALTH LICENSE
IL148229OtherMEDICARE PTAN