Provider Demographics
NPI:1598845661
Name:TLC HEALTHCARE SERVICES OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:TLC HEALTHCARE SERVICES OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-403-7139
Mailing Address - Street 1:950 MILWAUKEE AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3710
Mailing Address - Country:US
Mailing Address - Phone:847-403-7139
Mailing Address - Fax:847-827-5469
Practice Address - Street 1:950 MILWAUKEE AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3710
Practice Address - Country:US
Practice Address - Phone:847-403-7139
Practice Address - Fax:847-827-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010467251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147869Medicare ID - Type UnspecifiedPROVIDER NUMBER