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NPI Code Detail

MEDICARE: ILLINOIS FAMILY HOME HEALTH SERVICES, LLC

MEDICARE: ILLINOIS FAMILY HOME HEALTH SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency2019992IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12019992OTHERILILLINOIS STATE LICENSE

General Provider Information

NPI Number : 1154604031
Entity Type Code : Organization
Provider Name (Legal Business Name) : ILLINOIS FAMILY HOME HEALTH SERVICES, LLC
Provider Business Mailing Address
First Line : 2401 W US HIGHWAY 20
Second Line : #200
City : PINGREE GROVE
State : IL
Zip : 60140-8818
Country : US
Telephone Number : 847-972-1590
Fax Number : 847-972-1544
Provider Business Practice Location Address
First Line : 2401 W US HIGHWAY 20
Second Line : #200
City : PINGREE GROVE
State : IL
Zip : 60140-8818
Country : US
Telephone Number : 847-972-1590
Fax Number : 847-972-1544
Authorized Official
Title or Position : ADMINISTRATOR
Name : ABRAHAM MATHAI
Credential :
Telephone Number : 847-972-1590
Provider Enumeration Date : 09/27/2011
Last Update Date : 09/27/2011

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Directions to “ILLINOIS FAMILY HOME HEALTH SERVICES, LLC ” Practice Location

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