Organization Name: | ILLINOIS EXPRESS HOME CARE |
NPI Number: | 1013269737 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DIANE SHELTON (ADMINISTRATOR) |
Mailing Address: | 4601 State St East Saint Louis |
State: | IL US |
Postal Code: | 622051359 |
Phone Number: | 3147270453 |
Fax Number: | |
NPI Enumeration Date: | 10/04/2012 |
NPI Last Update Date: | 10/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 253Z00000X |
License Number: | 4000369 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Agencies |
Taxonomy Classification: | In Home Supportive Care |
Taxonomy Specialization: | |
Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |