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General NPI Number Information
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NPI Number | 1396183950
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Entity Type | Organization
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Legal Business Name | ASSYRIAN NATIONAL COUNCIL OF ILLINOIS
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 2450 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-4113
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Country | US
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Telephone | 773-262-5589
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Fax | 773-262-0828
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Provider Business Mailing Address
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Address Line | 2450 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-4113
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Country | US
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Telephone | 773-262-5589
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Fax | 773-262-0828
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ISHO LILOU
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Credential |
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Telephone | 773-262-5589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 5422-449-4
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License Number State | IL
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