Provider Demographics
NPI:1659316339
Name:INSTITUTE OF FAMILY CARE
Entity Type:Organization
Organization Name:INSTITUTE OF FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:815-963-1596
Mailing Address - Street 1:417 S PIERPONT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-1656
Mailing Address - Country:US
Mailing Address - Phone:815-963-1596
Mailing Address - Fax:
Practice Address - Street 1:417 S PIERPONT AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-1656
Practice Address - Country:US
Practice Address - Phone:815-963-1596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health