Healthcare Provider Details

I. General information

NPI: 1326754102
Provider Name (Legal Business Name): FIRST RESPONSE IN-HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22765 WOODLAWN AVE
STEGER IL
60475-6011
US

IV. Provider business mailing address

22765 WOODLAWN AVE
STEGER IL
60475-6011
US

V. Phone/Fax

Practice location:
  • Phone: 708-420-8552
  • Fax:
Mailing address:
  • Phone: 708-420-8552
  • Fax:

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 Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JASMINE REYNOLDS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 708-420-8552