Provider Demographics
NPI:1356655039
Name:ASSISTIVE HEALTHCARE AGENCY
Entity Type:Organization
Organization Name:ASSISTIVE HEALTHCARE AGENCY
Other - Org Name:KRISTEN N IBARRA DELGADO DBA ASSISTIVE HEALTHCARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPN/NURSE
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE/KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDANZ/IBARRA DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-366-1994
Mailing Address - Street 1:PO BOX 1232
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60078-1232
Mailing Address - Country:US
Mailing Address - Phone:847-366-1994
Mailing Address - Fax:
Practice Address - Street 1:1332 INVERRARY LN
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2108
Practice Address - Country:US
Practice Address - Phone:847-366-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care