Open Waters Home Health Care, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1010778 Issued in IL

Legal business name

OPEN WATERS HOME HEALTH CARE, INC.

Practice address

5940 W Touhy Avenue
Suite #145
Niles, IL 60714-4613

Phone

(847) 329-8585

Fax

(847) 329-8181

NPI assigned

Dec 4, 2007

Last updated

Oct 24, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Leodelfin C Dy

Title

Administrator/President

Phone

(847) 329-8585

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033391750. Details of each certification follow.

• CCN 148056 Home health agency · Active · Details

Home health agency certification: CCN 148056

Legal name

OPEN WATERS HOME HEALTH CARE, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Mar 9, 2009

Last certification

Dec 31, 2020

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Mar 1, 2007 in IL

Enrollment address

5940 W Touhy Avenue
Suite 145
Niles, IL 60714-4638

Listed as

Open Waters Home Health Care, IncCCN 148056 · All quality measures

Ownership

Proprietary

Certified

Mar 9, 2009

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 4

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

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571875200000",
    "number": "1033391750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 W TOUHY AVENUE",
            "address_2": "SUITE #145",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607144613",
            "telephone_number": "847-329-8585",
            "fax_number": "847-329-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5940 W TOUHY AVENUE",
            "address_2": "SUITE #145",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607144613",
            "telephone_number": "847-329-8585",
            "fax_number": "847-329-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN WATERS HOME HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2019-10-24",
        "status": "A",
        "authorized_official_last_name": "DY",
        "authorized_official_first_name": "LEODELFIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR/PRESIDENT",
        "authorized_official_telephone_number": "847-329-8585",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1010778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D1069867",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF PUBLIC HEALTH",
            "identifier": "1010778",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.