Provider Demographics
NPI:1770886061
Name:ILLINOIS HOME MED VISITS
Entity type:Organization
Organization Name:ILLINOIS HOME MED VISITS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:SALVATIERRA
Authorized Official - Last Name:SAJOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-631-6000
Mailing Address - Street 1:7257 W TOUHY AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-4342
Mailing Address - Country:US
Mailing Address - Phone:773-631-6000
Mailing Address - Fax:773-894-7772
Practice Address - Street 1:820 E OLD WILLOW RD
Practice Address - Street 2:UNIT #112
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-2152
Practice Address - Country:US
Practice Address - Phone:773-631-6000
Practice Address - Fax:773-894-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070414208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty