Provider Demographics
NPI:1477512796
Name:IROQUOIS HOME CARE, INC.
Entity Type:Organization
Organization Name:IROQUOIS HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-432-7735
Mailing Address - Street 1:200 NORTH LAIRD LANE
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1666
Mailing Address - Country:US
Mailing Address - Phone:815-432-6155
Mailing Address - Fax:
Practice Address - Street 1:200 NORTH LAIRD LANE
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1666
Practice Address - Country:US
Practice Address - Phone:815-432-6155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000072332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200155460AMedicaid
03870198OtherBC/BS
03870198OtherBC/BS