| Villasenor In-home Patient Care Llc | |
|
1639 Oak Park Ave Berwyn IL 60402-1782 | |
| (708) 788-2801 | |
| (847) 787-5252 |
| Full Name | Villasenor In-home Patient Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1639 Oak Park Ave, Berwyn, Illinois |
| Authorized Official Name and Position | Jerry Villasenor (FAMILY PRACTICE) |
| Authorized Official Contact | 7087882801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Villasenor In-home Patient Care Llc 1639 Oak Park Ave Berwyn IL 60402-1782 Ph: (708) 788-2801 | Villasenor In-home Patient Care Llc 1639 Oak Park Ave Berwyn IL 60402-1782 Ph: (708) 788-2801 |
| NPI Number | 1780006619 |
|---|---|
| Provider Enumeration Date | 01/12/2014 |
| Last Update Date | 01/12/2014 |
| Medicare PECOS PAC ID | 7618192550 |
|---|---|
| Medicare Enrollment ID | O20140708002236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780006619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036-111596 (Illinois) | Primary |
| Provider Name | Jerry Villasenor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831107135 PECOS PAC ID: 8224052402 Enrollment ID: I20060116000379 |
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