Provider Demographics
NPI:1639644800
Name:ILLINOIS HOME CARE SPECIALISTS INC
Entity Type:Organization
Organization Name:ILLINOIS HOME CARE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-493-9328
Mailing Address - Street 1:123 E LAKE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1100
Mailing Address - Country:US
Mailing Address - Phone:630-283-3637
Mailing Address - Fax:847-278-1189
Practice Address - Street 1:123 E LAKE ST STE 204
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1100
Practice Address - Country:US
Practice Address - Phone:630-283-3637
Practice Address - Fax:847-278-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No332U00000XSuppliersHome Delivered Meals
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid