Provider Demographics
NPI:1548375447
Name:MEDTEC HOME HEALTH AGENCY, INC.
Entity type:Organization
Organization Name:MEDTEC HOME HEALTH AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRABHAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-681-2009
Mailing Address - Street 1:10001 W ROOSEVELT RD STE 306
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2662
Mailing Address - Country:US
Mailing Address - Phone:708-681-2009
Mailing Address - Fax:708-575-2166
Practice Address - Street 1:10001 W ROOSEVELT RD STE 306
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2662
Practice Address - Country:US
Practice Address - Phone:708-681-2009
Practice Address - Fax:708-575-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010201251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147739Medicare Oscar/Certification