Provider Demographics
NPI:1831469394
Name:INDEPENDENCE HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:INDEPENDENCE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOOMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-481-6525
Mailing Address - Street 1:5648 W. LAWRENCE AVE,, SUITE A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3220
Mailing Address - Country:US
Mailing Address - Phone:773-481-6525
Mailing Address - Fax:773-481-6528
Practice Address - Street 1:5648 W LAWRENCE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3220
Practice Address - Country:US
Practice Address - Phone:773-481-6525
Practice Address - Fax:773-481-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011389261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011389OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH LICENSE