1972834166 NPI number — EHS HOME HEALTH CARE SERVICE INC

Table of content: (NPI 1972834166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972834166 NPI number — EHS HOME HEALTH CARE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EHS HOME HEALTH CARE SERVICE 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:
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:
1972834166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2311 W 22ND ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-572-1232
Provider Business Mailing Address Fax Number:
630-368-5912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 N HERSHEY RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61704-3576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-888-0930
Provider Business Practice Location Address Fax Number:
309-268-5960
Provider Enumeration Date:
01/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BURRELL PACE
Authorized Official First Name:
TONIA
Authorized Official Middle Name:
YOLANDA
Authorized Official Title or Position:
DIRECTOR, PATIENT ACCOUNTS
Authorized Official Telephone Number:
630-368-6570

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1001932 , 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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