Provider Demographics
NPI:1659020642
Name:SHIRETTE'S IN HOME CARE, LLC
Entity Type:Organization
Organization Name:SHIRETTE'S IN HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-669-6504
Mailing Address - Street 1:3526 N CALIFORNIA AVE STE 100B
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-1143
Mailing Address - Country:US
Mailing Address - Phone:309-669-6504
Mailing Address - Fax:309-590-5590
Practice Address - Street 1:3526 N CALIFORNIA AVE STE 100B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-1143
Practice Address - Country:US
Practice Address - Phone:309-669-6504
Practice Address - Fax:309-590-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center