Provider Demographics
NPI:1174619324
Name:RELIACARE, LTD
Entity type:Organization
Organization Name:RELIACARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-960-5100
Mailing Address - Street 1:6900 MAIN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3454
Mailing Address - Country:US
Mailing Address - Phone:630-960-5100
Mailing Address - Fax:630-960-5181
Practice Address - Street 1:6900 MAIN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3454
Practice Address - Country:US
Practice Address - Phone:630-960-5100
Practice Address - Fax:630-960-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1009448251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147693Medicare ID - Type UnspecifiedPROVIDER NUMBER