Provider Demographics
NPI:1053588343
Name:VIRGOS HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:VIRGOS HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WACHARES
Authorized Official - Middle Name:
Authorized Official - Last Name:VATHANANAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-965-8914
Mailing Address - Street 1:8930 GROSS POINT RD
Mailing Address - Street 2:STE. LL100
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1858
Mailing Address - Country:US
Mailing Address - Phone:847-965-8914
Mailing Address - Fax:847-965-8916
Practice Address - Street 1:8930 GROSS POINT RD
Practice Address - Street 2:STE. LL100
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1858
Practice Address - Country:US
Practice Address - Phone:847-965-8914
Practice Address - Fax:847-965-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010754251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010754OtherSTATE OF ILLINOIS DEPARTMENT OF PUBLIC HEALTH