Provider Demographics
NPI:1609521582
Name:INTERIM HEALTHCARE SERVICES OF JOLIET, INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE SERVICES OF JOLIET, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GERICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-725-9091
Mailing Address - Street 1:310 N HAMMES AVE STE 301E
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8147
Mailing Address - Country:US
Mailing Address - Phone:815-725-9091
Mailing Address - Fax:815-725-9094
Practice Address - Street 1:310 N HAMMES AVE STE 301E
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8147
Practice Address - Country:US
Practice Address - Phone:815-725-9091
Practice Address - Fax:815-725-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4000120Medicaid