Healthcare Provider Details

I. General information

NPI: 1053459032
Provider Name (Legal Business Name): NORTHERN ILLINOIS HOME HEALTHCARE CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 LAKE CORNISH WAY
ALGONQUIN IL
60102-5029
US

IV. Provider business mailing address

630 LAKE CORNISH WAY
ALGONQUIN IL
60102-5029
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-2360
  • Fax:
Mailing address:
  • Phone: 847-658-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMELIA CUSTODIO
Title or Position: PRESIDENT
Credential:
Phone: 847-658-2360