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General NPI Number Information
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NPI Number | 1467754994
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Entity Type | Organization
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Legal Business Name | SOLID SOURCE HEALTHCARE RESOURCES LLC HOME SERVICES
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Dates
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Enumeration Date | 12/05/2010
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 100 W SUPERIOR ST UNIT 1
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City | OTTAWA
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State | IL
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Zip | 61350-2093
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Country | US
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Telephone | 815-324-9396
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Fax | 888-577-1171
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Provider Business Mailing Address
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Address Line | 911 OTTAWA AVE UNIT 2
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City | OTTAWA
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State | IL
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Zip | 61350-3321
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Country | US
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Telephone | 779-279-4888
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Fax | 888-577-1171
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TOSHETA D BROWN-GREENFIELD
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Credential | RN
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Telephone | 815-324-9396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 4000322
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License Number State | IL
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