1194948976 NPI number — IMMANUEL HOME CARE SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194948976 NPI number — IMMANUEL HOME CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMMANUEL HOME CARE SERVICES, INC.
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:
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:
1194948976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 E 47TH ST
Provider Second Line Business Mailing Address:
SUITE 301E
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60653-4202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-285-2227
Provider Business Mailing Address Fax Number:
773-285-3033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 E 47TH ST
Provider Second Line Business Practice Location Address:
SUITE 301E
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60653-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-285-2227
Provider Business Practice Location Address Fax Number:
773-285-3033
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
EDWARDS
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
815-577-7192

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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)





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