{
"Npi": {
"NPI": "1083847891",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CENTER OF ILLINOIS HOME HEALTHCARE, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "855 E GOLF RD",
"SecondLineMailingAddress": "SUITE 2134",
"MailingAddressCityName": "ARLINGTON HEIGHTS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60005-5222",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-437-0774",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "855 E GOLF RD STE 2147",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ARLINGTON HEIGHTS",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60005-5225",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-437-0774",
"PracticeLocationAddressFaxNumber": "847-437-0776",
"EnumerationDate": "08/26/2009",
"LastUpdateDate": "05/05/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GORR",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "847-437-0774",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "1011077",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}