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General NPI Number Information
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NPI Number | 1053459032
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS HOME HEALTHCARE CO.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 630 LAKE CORNISH WAY
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City | ALGONQUIN
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State | IL
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Zip | 60102-5029
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Country | US
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Telephone | 847-658-2360
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Fax |
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Provider Business Mailing Address
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Address Line | 630 LAKE CORNISH WAY
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City | ALGONQUIN
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State | IL
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Zip | 60102-5029
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Country | US
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Telephone | 847-658-2360
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMELIA CUSTODIO
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Credential |
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Telephone | 847-658-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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