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General NPI Number Information
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NPI Number | 1477512796
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Entity Type | Organization
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Legal Business Name | IROQUOIS HOME CARE, INC.
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 200 NORTH LAIRD LANE
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City | WATSEKA
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State | IL
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Zip | 60970-1666
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Country | US
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Telephone | 815-432-6155
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Fax |
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Provider Business Mailing Address
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Address Line | 200 NORTH LAIRD LANE
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City | WATSEKA
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State | IL
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Zip | 60970-1666
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Country | US
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Telephone | 815-432-6155
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES BOHLMANN
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Credential |
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Telephone | 815-432-7735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 203000072
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License Number State | IL
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