1043732373 NPI number — IHCC LLC

Table of content: (NPI 1043732373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043732373 NPI number — IHCC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IHCC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043732373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61356-0057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-343-0572
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 W PERU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61356-6803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-872-7447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
815-872-7447

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  3001523 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 4000549 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3001523 . This is a "IDPH HOME SERVICES AGENCY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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