Provider Demographics
NPI:1467754994
Name:SOLID SOURCE HEALTHCARE RESOURCES LLC HOME SERVICES
Entity Type:Organization
Organization Name:SOLID SOURCE HEALTHCARE RESOURCES LLC HOME SERVICES
Other - Org Name:SOLID SOURCE HEALTHCARE RESOURCES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TOSHETA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN-GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-324-9396
Mailing Address - Street 1:911 OTTAWA AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3321
Mailing Address - Country:US
Mailing Address - Phone:779-279-4888
Mailing Address - Fax:888-577-1171
Practice Address - Street 1:100 W SUPERIOR ST
Practice Address - Street 2:UNIT 1
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2093
Practice Address - Country:US
Practice Address - Phone:815-324-9396
Practice Address - Fax:888-577-1171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLID SOURCE HEALTHCARE RESOURCES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-05
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000322251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care