Provider Demographics
NPI:1053459032
Name:NORTHERN ILLINOIS HOME HEALTHCARE CO.
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS HOME HEALTHCARE CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSTODIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-658-2360
Mailing Address - Street 1:630 LAKE CORNISH WAY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5029
Mailing Address - Country:US
Mailing Address - Phone:847-658-2360
Mailing Address - Fax:
Practice Address - Street 1:630 LAKE CORNISH WAY
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5029
Practice Address - Country:US
Practice Address - Phone:847-658-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health