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General NPI Number Information
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NPI Number | 1295062404
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Entity Type | Organization
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Legal Business Name | DOMINION HOME HEALTH CARE INC.
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3434 RIDGE RD
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City | LANSING
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State | IL
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Zip | 60438-3102
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Country | US
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Telephone | 708-858-6132
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Fax | 708-858-6156
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Provider Business Mailing Address
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Address Line | 3434 RIDGE RD
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City | LANSING
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State | IL
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Zip | 60438-3102
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Country | US
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Telephone | 708-858-6132
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Fax | 708-858-6156
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Authorized Official
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Title or Position | ADMINISTATOR
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Name | VICTOR OKEZIE IKE
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Credential |
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Telephone | 708-527-0808
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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 | IL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1011216
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License Number State | IL
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