Healthcare Provider Details

I. General information

NPI: 1043732373
Provider Name (Legal Business Name): IHCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N MAIN ST
PRINCETON IL
61356-1329
US

IV. Provider business mailing address

602 N MAIN ST
PRINCETON IL
61356-1329
US

V. Phone/Fax

Practice location:
  • Phone: 815-872-7447
  • Fax:
Mailing address:
  • Phone: 815-872-7447
  • Fax: 855-356-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4000549
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3001523
License Number StateIL

VIII. Authorized Official

Name: KIMBERLY PARK
Title or Position: OWNER
Credential:
Phone: 815-872-7447