Provider Demographics
NPI:1275857096
Name:INTEGRATED HOME CARE SERVICES CHICAGO
Entity Type:Organization
Organization Name:INTEGRATED HOME CARE SERVICES CHICAGO
Other - Org Name:INTEGRATED RESPIRATORY SOLUTIONS PROVENA
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-582-0202
Mailing Address - Street 1:480 LAKE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3581
Mailing Address - Country:US
Mailing Address - Phone:630-582-0202
Mailing Address - Fax:630-582-3787
Practice Address - Street 1:195 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6507
Practice Address - Country:US
Practice Address - Phone:815-725-6161
Practice Address - Fax:818-725-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35035943332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5126960002Medicare UPIN