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General NPI Number Information
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NPI Number | 1689918559
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Entity Type | Organization
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Legal Business Name | DEMIRICH INC
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 350 VICTORY DR # 142
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City | PARK FOREST
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State | IL
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Zip | 60466-2003
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Country | US
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Telephone | 708-283-0916
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Fax | 708-260-9404
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Provider Business Mailing Address
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Address Line | 350 VICTORY DR # 142
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City | PARK FOREST
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State | IL
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Zip | 60466-2003
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Country | US
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Telephone | 708-283-0916
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Fax | 708-260-9404
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. RICHELLE HOWELL
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Credential | R.N.
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Telephone | 708-254-4456
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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 | 3000400
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License Number State | IL
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