1598947418 NPI number — INGALLS HOME CARE

Table of content: (NPI 1598947418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598947418 NPI number — INGALLS HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INGALLS HOME CARE
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:
INGALLS PRIVATE DUTY HOME NURSING AGENCY
Provider Other Organization Name Type Code:
3
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:
1598947418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 INGALLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARVEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60426-3558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-331-0226
Provider Business Mailing Address Fax Number:
708-915-2749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 INGALLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60426-3558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-331-0226
Provider Business Practice Location Address Fax Number:
708-915-2749
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FELIKSIK
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST DIRECTOR QUALITY & COMPLIANCE
Authorized Official Telephone Number:
708-331-0226

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1636254 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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