Provider Demographics
NPI:1922092006
Name:INTERIM HEALTHCARE SERVICES OF JOLIET, INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE SERVICES OF JOLIET, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-725-9091
Mailing Address - Street 1:310 N HAMMES AVE
Mailing Address - Street 2:STE 301E
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8118
Mailing Address - Country:US
Mailing Address - Phone:815-725-9091
Mailing Address - Fax:815-725-9094
Practice Address - Street 1:310 N HAMMES AVE
Practice Address - Street 2:STE 301E
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8118
Practice Address - Country:US
Practice Address - Phone:815-725-9091
Practice Address - Fax:815-725-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1002559251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid