1275857096 NPI number — INTEGRATED HOME CARE SERVICES CHICAGO

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 1275857096 NPI number — INTEGRATED HOME CARE SERVICES CHICAGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HOME CARE SERVICES CHICAGO
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:
1275857096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 LAKE ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ROSELLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60172-3581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-582-0202
Provider Business Mailing Address Fax Number:
630-582-3787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-6507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-725-6161
Provider Business Practice Location Address Fax Number:
818-725-1139
Provider Enumeration Date:
03/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
630-582-0202

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  35035943 , 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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