Provider Demographics
NPI:1043732373
Name:IHCC LLC
Entity Type:Organization
Organization Name:IHCC LLC
Other - Org Name:IN-HOME CARE CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-872-7447
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-0057
Mailing Address - Country:US
Mailing Address - Phone:815-343-0572
Mailing Address - Fax:
Practice Address - Street 1:680 W PERU ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-6803
Practice Address - Country:US
Practice Address - Phone:815-872-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000549251E00000X, 251E00000X
IL3001523253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001523OtherIDPH HOME SERVICES AGENCY
IL4000549OtherIDPH HOME NURSING AGENCY LICENSE NUMBER