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General NPI Number Information
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NPI Number | 1316991573
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Entity Type | Organization
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Legal Business Name | I J HEALTHCARE NURSING RESOURCE LLC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8200 185TH ST STE H14
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City | TINLEY PARK
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State | IL
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Zip | 60487-9308
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Country | US
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Telephone | 708-620-8599
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Fax | 708-620-8874
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Provider Business Mailing Address
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Address Line | 8130 APACHE TRL
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City | TINLEY PARK
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State | IL
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Zip | 60477-6530
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Country | US
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Telephone | 708-620-8599
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Fax | 708-620-8874
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Authorized Official
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Title or Position | OWNER
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Name | MS. JOLLY SAMUEL
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Credential | RN
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Telephone | 708-620-8599
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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 | 1010445
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License Number State | IL
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