Provider Demographics
NPI:1417998865
Name:INGALLS HOME CARE
Entity Type:Organization
Organization Name:INGALLS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELIKSIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-331-0226
Mailing Address - Street 1:ONE INGALLS DRIVE
Mailing Address - Street 2:WYMAN GORDON PAVILION
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426
Mailing Address - Country:US
Mailing Address - Phone:708-331-0226
Mailing Address - Fax:708-915-2749
Practice Address - Street 1:ONE INGALLS DRIVE
Practice Address - Street 2:WYMAN GORDON PAVILION
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-331-0226
Practice Address - Fax:708-915-2749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001338251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9712OtherBLUE CROSS PROVIDER NUMBE
147435Medicare ID - Type UnspecifiedPROVIDER NUMBER
IL9712OtherBLUE CROSS PROVIDER NUMBE