NPIMap

Organization Active NPI

Nightingale Home Healthcare of Illinois Inc

  • Home Health Agency
  • Willowbrook, IL
National Provider Identifier
1174504286
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1010241 Issued in IL
Legal business name
NIGHTINGALE HOME HEALTHCARE OF ILLINOIS INC
Practice address
628 Executive Dr
Willowbrook, IL 60527-5610
Phone
(630) 654-2300
Fax
(630) 654-0800
NPI assigned
Nov 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2020

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

Authorized official

Name
Dr. Dev Brar
Title
Owner
Phone
(866) 334-7774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1010241 IL Primary

Addresses

Primary practice location

628 Executive Dr
Willowbrook, IL 60527-5610

Mailing address

PO Box 1710
Carmel, IN 46082-1710
Phone (866) 334-7774

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030403000023 IL Part A Provider - Home Health Agency 2062321177 Practice locations: Willowbrook, IL

Home health agency certification: CCN 147740

Legal name
NIGHTINGALE HOME HEALTHCARE OF ILLINOIS INC
Doing business as
NIGHTINGALE HOME HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 23, 2003
Last certification
Nov 1, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Dec 6, 2002 in IL
Enrollment address
628 Executive Dr
Willowbrook, IL 60527-5610
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Nightingale Home Healthcare of Illinois, IncCCN 147740
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Jul 23, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1008241Nightingale Home Healthcare of Il Inc628 Executive Dr, Willowbrook, IL 60527Certificate of waiverJan 13, 2027

National Provider Directory

National Provider Directory

Locations

16W273 83rd St
Ste B2
Burr Ridge, IL 60527
Phone (630) 654-2300

628 Executive Dr
Willowbrook, IL 60527
Phone (630) 654-2300

Ownership & related parties

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.

NameRoleSinceShare
Homecare Providers Inc Organization, Carmel, IN For-profit 5% Or Greater Direct Ownership Interest Nov 28, 2006 100%
Dev a Brar Individual 5% Or Greater Indirect Ownership Interest Dec 6, 2002 100%
Corporate OfficerPresident Dec 6, 2002 100%
Corporate DirectorPresident Dec 6, 2002 100%
David a Pratt Individual W-2 Managing EmployeeCfo Nov 28, 2006 5%
Piper L Brar Individual W-2 Managing EmployeeAssistant Director Nov 28, 2006 5%

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1174504286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1710",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460821710",
            "telephone_number": "866-334-7774",
            "fax_number": "317-569-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 EXECUTIVE DR",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605275610",
            "telephone_number": "630-654-2300",
            "fax_number": "630-654-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIGHTINGALE HOME HEALTHCARE OF ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A",
        "authorized_official_last_name": "BRAR",
        "authorized_official_first_name": "DEV",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "866-334-7774",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1010241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willowbrook, IL

Sources for this page

Verify at the official NPI Registry.