Provider Demographics
NPI:1316991573
Name:I J HEALTHCARE NURSING RESOURCE LLC
Entity type:Organization
Organization Name:I J HEALTHCARE NURSING RESOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-620-8599
Mailing Address - Street 1:8130 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6530
Mailing Address - Country:US
Mailing Address - Phone:708-620-8599
Mailing Address - Fax:708-620-8874
Practice Address - Street 1:8200 185TH ST STE H14
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9308
Practice Address - Country:US
Practice Address - Phone:708-620-8599
Practice Address - Fax:708-620-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010445251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147939Medicare Oscar/Certification