Healthcare Provider Details

I. General information

NPI: 1952862617
Provider Name (Legal Business Name): ISR ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 PHELPS AVE, BLDG 10, STE 1008
ROCKFORD IL
61108
US

IV. Provider business mailing address

129 PHELPS AVE, BLDG 10, STE 1008
ROCKFORD IL
61108
US

V. Phone/Fax

Practice location:
  • Phone: 815-395-8790
  • Fax: 815-395-8790
Mailing address:
  • Phone: 815-395-8790
  • Fax: 815-395-8790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DANIEL KNIPSCHIELD
Title or Position: OWNER
Credential:
Phone: 815-395-8790