Provider Demographics
NPI:1306371406
Name:ILLINOIS HOMECARE AND TRAINING, INC.
Entity Type:Organization
Organization Name:ILLINOIS HOMECARE AND TRAINING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:NWOSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-759-0760
Mailing Address - Street 1:4554 N. BROADWAY STREET
Mailing Address - Street 2:SUITE 316
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-455-5696
Mailing Address - Fax:773-784-5154
Practice Address - Street 1:4554 N. BROADWAY STREET
Practice Address - Street 2:SUITE 316
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-455-5696
Practice Address - Fax:773-784-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL251E00000XMedicaid