Ebenezer Home Health Service, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

EBENEZER HOME HEALTH SERVICE, LLC

Practice address

16860 Oak Park Ave Ste 201C
Tinley Park, IL 60477-2787

Phone

(708) 444-8511

Fax

(708) 570-0800

NPI assigned

Feb 2, 2007

Organization subpart

No

Name

Marilou Villasenor

Title

President

Phone

(773) 793-8627

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Maria Rhodora Espinas Chan, M.D.

  • Internal Medicine Physician
  • Oak Forest, IL
  • NPI 1760770481

  Corporate Officer

  CMS ownership

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

• Sarkis Michael Bedikian, D.O.

  • Orthopaedic Surgery Physician
  • Palos Hills, IL
  • NPI 1457590457

  Home health agency

  Care Compare affiliation
• George Branovacki, MD

  • Orthopaedic Surgery Physician
  • Orland Park, IL
  • NPI 1083661086

  Home health agency

  Care Compare affiliation
• Kevin Gerardo Lindsay-Rivera, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Palos Hills, IL
  • NPI 1942869482

  Home health agency

  Care Compare affiliation

Listed as

Ebenezer Home Health Service, LLCCCN 148022

Overall star rating

4 of 5

Ownership

Proprietary

Certified

Oct 16, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Services

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

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

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in IL

Legal name

EBENEZER HOME HEALTH SERVICE, LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Oct 16, 2008

Last certification

May 19, 2017

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Oct 23, 2006 in IL

Enrollment address

16860 Oak Park Ave
Ste 201C
Tinley Park, IL 60477-2787

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

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 7, 2021.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625616000000",
    "number": "1215075932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16860 OAK PARK AVE STE 201C",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772787",
            "telephone_number": "708-444-8511",
            "fax_number": "708-444-8514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16860 OAK PARK AVE STE 201C",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772787",
            "telephone_number": "708-444-8511",
            "fax_number": "708-570-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HOME HEALTH SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A",
        "authorized_official_last_name": "VILLASENOR",
        "authorized_official_first_name": "MARILOU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-793-8627"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215075932",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215075932001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF PUBLIC HEALTH",
            "identifier": "1010723",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary T Dwyer
• Julie Ann Dykstra, LCPC, CADC, SAP, MAC
• Dyna Care Home Health, Inc.
• Easter Seals Metropolitan Chicago
• Kathleen Easton
• Alexa Eberhard, CCN, LDN
• Ebs Pediatrics
• Michael Dennis Egan, D.D.S.
• Paula A Eggert, LCSW
• Karl Ehlers

• All providers in Tinley Park, IL
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; 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.