Provider Demographics
NPI:1376060020
Name:ILLINOIS WEST CENTRAL HOME CARE CORP
Entity Type:Organization
Organization Name:ILLINOIS WEST CENTRAL HOME CARE CORP
Other - Org Name:VISITING ANGELS OF PEORIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIMERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-998-1000
Mailing Address - Street 1:4507 N STERLING AVE STE 401A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3860
Mailing Address - Country:US
Mailing Address - Phone:309-998-1000
Mailing Address - Fax:
Practice Address - Street 1:4507 N STERLING AVE STE 401A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3860
Practice Address - Country:US
Practice Address - Phone:309-998-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care