Provider Demographics
NPI:1518284587
Name:COMPLETE HOME RESPIRATORY CARE LLC
Entity Type:Organization
Organization Name:COMPLETE HOME RESPIRATORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HORACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-635-6096
Mailing Address - Street 1:2108 W TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1547
Mailing Address - Country:US
Mailing Address - Phone:309-689-5038
Mailing Address - Fax:309-689-5074
Practice Address - Street 1:2108 W TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1547
Practice Address - Country:US
Practice Address - Phone:309-689-5038
Practice Address - Fax:309-689-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL39874656332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies