Provider Demographics
NPI:1629268388
Name:ILLINOIS HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:ILLINOIS HOME HEALTH SERVICES
Other - Org Name:ILLINOIS HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALESA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANGALINDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-884-6080
Mailing Address - Street 1:1355 REMINGTON RD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4818
Mailing Address - Country:US
Mailing Address - Phone:847-884-6080
Mailing Address - Fax:847-884-6084
Practice Address - Street 1:1355 REMINGTON RD
Practice Address - Street 2:SUITE Q
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4818
Practice Address - Country:US
Practice Address - Phone:847-884-6080
Practice Address - Fax:847-884-6084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILLINOIS HOME HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010354251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010354Medicaid