Provider Demographics
NPI:1659617017
Name:SOUTH ELGIN IN-HOME PERSONAL CARE INC.
Entity Type:Organization
Organization Name:SOUTH ELGIN IN-HOME PERSONAL CARE INC.
Other - Org Name:HOME HELPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-584-3361
Mailing Address - Street 1:5N911 DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:CAMPTON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60175-8225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5N911 DOMINION DR
Practice Address - Street 2:
Practice Address - City:CAMPTON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60175-8225
Practice Address - Country:US
Practice Address - Phone:630-584-3361
Practice Address - Fax:630-584-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000282253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care