Provider Demographics
NPI:1891231957
Name:IDEAL HOME CARE, LLC
Entity Type:Organization
Organization Name:IDEAL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-972-6872
Mailing Address - Street 1:5559 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2621
Mailing Address - Country:US
Mailing Address - Phone:847-972-6872
Mailing Address - Fax:877-904-2920
Practice Address - Street 1:5559 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2621
Practice Address - Country:US
Practice Address - Phone:847-972-6872
Practice Address - Fax:877-904-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001203253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care