Provider Demographics
NPI:1447491519
Name:HOME LIFE HEALTHCARE, CORP.
Entity type:Organization
Organization Name:HOME LIFE HEALTHCARE, CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHTANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-143-1611
Mailing Address - Street 1:1020 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1340
Mailing Address - Country:US
Mailing Address - Phone:847-413-1611
Mailing Address - Fax:847-908-9011
Practice Address - Street 1:1020 W GOLF RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1340
Practice Address - Country:US
Practice Address - Phone:847-413-1611
Practice Address - Fax:847-908-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010985251E00000X, 251F00000X
251J00000X
IL3000861253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3002017OtherSTATE OF ILLINOIS - HOME SERVICE AGENCY
IL4000692OtherSTATE OF ILLINOIS - HOME NURSING AGENCY
IL1012066OtherSTATE OF ILLINOIS - HOME HEALTH