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General NPI Number Information
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NPI Number | 1972087922
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Entity Type | Organization
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Legal Business Name | LILLIE'S CIRCLE OF CARE
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Dates
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Enumeration Date | 09/16/2018
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Last Update Date | 09/16/2018
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Provider Practice Location Address
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Address Line | 1355 LONG BOAT KEY LN
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City | ELGIN
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State | IL
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Zip | 60120-7589
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Country | US
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Telephone | 323-447-6718
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 LONG BOAT KEY LN
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City | ELGIN
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State | IL
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Zip | 60120-7589
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Country | US
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Telephone | 323-447-6718
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CONSTANCE LA VERNE KIZZIE-GILLETT
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Credential | ML
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Telephone | 323-447-6718
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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 |
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License Number State |
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