Provider Demographics
NPI:1386415313
Name:HOME CLINIX ILLINOIS LLC
Entity type:Organization
Organization Name:HOME CLINIX ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:HOLMGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-243-7333
Mailing Address - Street 1:39 PIER PL
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-4918
Mailing Address - Country:US
Mailing Address - Phone:801-243-7333
Mailing Address - Fax:
Practice Address - Street 1:259 E RAND RD STE 209B
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2184
Practice Address - Country:US
Practice Address - Phone:801-822-1880
Practice Address - Fax:801-890-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty