Healthcare Provider Details

I. General information

NPI: 1467443358
Provider Name (Legal Business Name): MCH OF ILLINOIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8145 RIVER DR
MORTON GROVE IL
60053-2645
US

IV. Provider business mailing address

PO BOX 16809
HATTIESBURG MS
39404-6809
US

V. Phone/Fax

Practice location:
  • Phone: 888-345-7337
  • Fax: 847-966-1240
Mailing address:
  • Phone: 601-268-1842
  • Fax: 601-268-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010132
License Number StateIL

VIII. Authorized Official

Name: MS. NANCY C JAKUS
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential: RN BSN MBA
Phone: 601-268-1842