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General NPI Number Information
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NPI Number | 1659617017
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Entity Type | Organization
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Legal Business Name | SOUTH ELGIN IN-HOME PERSONAL CARE INC.
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 5N911 DOMINION DR
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City | CAMPTON HILLS
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State | IL
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Zip | 60175-8225
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Country | US
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Telephone | 630-584-3361
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Fax | 630-584-4104
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Provider Business Mailing Address
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Address Line | 5N911 DOMINION DR
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City | CAMPTON HILLS
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State | IL
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Zip | 60175-8225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KATHY PETRICK
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Credential |
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Telephone | 630-584-3361
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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 | 3000282
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License Number State | IL
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