Provider Demographics
NPI:1639511066
Name:ILRC IN-HOME SERVICES, INC.
Entity type:Organization
Organization Name:ILRC IN-HOME SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-556-0400
Mailing Address - Street 1:1760 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2046
Mailing Address - Country:US
Mailing Address - Phone:573-556-0400
Mailing Address - Fax:573-556-0402
Practice Address - Street 1:1760 SOUTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2046
Practice Address - Country:US
Practice Address - Phone:573-556-0400
Practice Address - Fax:573-556-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care