Provider Demographics
NPI:1396183950
Name:ASSYRIAN NATIONAL COUNCIL OF ILLINOIS
Entity Type:Organization
Organization Name:ASSYRIAN NATIONAL COUNCIL OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISHO
Authorized Official - Middle Name:
Authorized Official - Last Name:LILOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-262-5589
Mailing Address - Street 1:2450 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4113
Mailing Address - Country:US
Mailing Address - Phone:773-262-5589
Mailing Address - Fax:773-262-0828
Practice Address - Street 1:2450 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4113
Practice Address - Country:US
Practice Address - Phone:773-262-5589
Practice Address - Fax:773-262-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5422-449-4253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care