1275857096 NPI number — INTEGRATED HOME CARE SERVICES CHICAGO

Table of content: (NPI 1275857096)

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)





Copyright © 2007-2025 www.npivalidator.com