NPIMap

Organization Active NPI

Phoenix Home Care, L.L.C.

  • Home Health Agency
  • Burr Ridge, IL
National Provider Identifier
1013928357
Registry record updated Jul 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1010174 Issued in IL
Legal business name
PHOENIX HOME CARE, L.L.C.
Practice address
15W700 N Frontage Rd Ste 136
Burr Ridge, IL 60527-7504
Phone
(630) 921-9400
Fax
(630) 654-5705
NPI assigned
Aug 11, 2006
Last updated
Jul 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dovi Weill
Title
Administrator
Phone
(630) 321-9400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1010174 IL Primary

Addresses

Primary practice location

15W700 N Frontage Rd Ste 136
Burr Ridge, IL 60527-7504

Mailing address

15W700 N Frontage Rd Ste 136
Burr Ridge, IL 60527-7504
Phone (630) 321-9400

Other identifiers 2

IdentifierTypeStateIssuer
50351OtherILBLUE CROSS/BLUE SHIELD
4518860001MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050509000357 IL Part A Provider - Home Health Agency 9638119720 Practice locations: Burr Ridge, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013928357. Details of each certification follow.

Home health agency certification: CCN 147730

Legal name
PHOENIX HOME CARE, LLC
Doing business as
HOME CARE EXPERTS
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 16, 2002
Last certification
Jun 19, 2015
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
15W700 N Frontage Rd
Ste 136
Burr Ridge, IL 60527-7504
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Home Care ExpertsCCN 147730 · All quality measures
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Dec 16, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

15W700 N Frontage Rd
Ste 136
Burr Ridge, IL 60527
Phone (630) 321-9400

200 S Frontage Rd
Ste 304
Burr Ridge, IL 60527

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jordan Reifer Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2020 18%
Corporate OfficerManager Dec 31, 2020
Cane Ip Hcxhh LLC Organization, Skokie, IL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2020 10%
Anc HH LLC Organization, Lincolnwood, IL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2020 10%
Patricia Miller Individual W-2 Managing Employee May 30, 2012
HCX Management, LLC Organization, Skokie, IL LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2020 55%
Lori Michelle Creamer Individual W-2 Managing Employee Oct 30, 2015
Home Care Experts, LLC Organization, Skokie, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 30, 2020 100%
Dov G Weill Individual 5% Or Greater Indirect Ownership Interest Dec 30, 2020 37%
Corporate OfficerManager Dec 31, 2020
W-2 Managing EmployeeAdministrator Dec 31, 2020

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Affiliated clinicians 136

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 136

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688860800000",
    "number": "1013928357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15W700 N FRONTAGE RD STE 136",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605277504",
            "telephone_number": "630-321-9400",
            "fax_number": "630-654-5705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15W700 N FRONTAGE RD STE 136",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605277504",
            "telephone_number": "630-921-9400",
            "fax_number": "630-654-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOME CARE, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2023-07-09",
        "certification_date": "2023-07-09",
        "status": "A",
        "authorized_official_last_name": "WEILL",
        "authorized_official_first_name": "DOVI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "630-321-9400"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1010174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "50351",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4518860001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

Verify at the official NPI Registry.