Provider Demographics
NPI:1356655039
Name:ASSISTIVE HEALTH CARE AGENCY LLC
Entity type:Organization
Organization Name:ASSISTIVE HEALTH CARE AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:IBARRA DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:224-393-1122
Mailing Address - Street 1:250 PARKWAY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-4340
Mailing Address - Country:US
Mailing Address - Phone:224-393-1122
Mailing Address - Fax:224-393-1121
Practice Address - Street 1:250 PARKWAY DR STE 150
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-4340
Practice Address - Country:US
Practice Address - Phone:224-393-1122
Practice Address - Fax:224-393-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty