Provider Demographics
NPI:1821391889
Name:SOLID SOURCE HEALTHCARE RESOURCES LLC
Entity Type:Organization
Organization Name:SOLID SOURCE HEALTHCARE RESOURCES LLC
Other - Org Name:SOLID SOURCE HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOSHETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-510-7109
Mailing Address - Street 1:100 W SUPERIOR ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2093
Mailing Address - Country:US
Mailing Address - Phone:815-510-7109
Mailing Address - Fax:
Practice Address - Street 1:911 OTTAWA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-3321
Practice Address - Country:US
Practice Address - Phone:815-510-7109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLID SOURCE HEALTHCARE RESOURCES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-14
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000691253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care