Provider Demographics
NPI:1154604031
Name:ILLINOIS FAMILY HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:ILLINOIS FAMILY HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-972-1590
Mailing Address - Street 1:2401 W US HIGHWAY 20
Mailing Address - Street 2:#200
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-8818
Mailing Address - Country:US
Mailing Address - Phone:847-972-1590
Mailing Address - Fax:847-972-1544
Practice Address - Street 1:2401 W US HIGHWAY 20
Practice Address - Street 2:#200
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-8818
Practice Address - Country:US
Practice Address - Phone:847-972-1590
Practice Address - Fax:847-972-1544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILLINOIS FAMILY HOME HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2019992251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2019992OtherILLINOIS STATE LICENSE
IL2019992OtherILLINOIS STATE LICENSE