1851351233 NPI number — RESIDENTIAL HOME HEALTH ILLINOIS, LLC

Table of content: (NPI 1851351233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851351233 NPI number — RESIDENTIAL HOME HEALTH ILLINOIS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESIDENTIAL HOME HEALTH ILLINOIS, 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:
1851351233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5440 CORPORATE DRIVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-902-4000
Provider Business Mailing Address Fax Number:
866-903-4000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 OPUS PLACE
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-902-4000
Provider Business Practice Location Address Fax Number:
866-903-4000
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-524-6401

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1006758 , 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: 1011738 , 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: 9875 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 36396225301 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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