MEDICARE: ILLINOIS INDEPENDENT LIVING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	253Z00000X	In Home Supportive Care Agency	12-HM8063-14	IL

General Provider Information

NPI Number	:	1043644743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS INDEPENDENT LIVING CENTER

Provider Business Mailing Address
First Line	:	1141 IROQUOIS AVE APT 104
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-9378
Country	:	US
Telephone Number	:	630-357-0077
Fax Number	:	630-357-0087

Provider Business Practice Location Address
First Line	:	1141 IROQUOIS AVE
Second Line	:	SUITE #104
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-9376
Country	:	US
Telephone Number	:	630-357-0077
Fax Number	:	630-357-0087

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANITA LOUISE DIERKS
Credential	:
Telephone Number	:	630-357-0077

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	03/27/2026

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