- Enrollment id
- O20091105000114
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1437391695
- Multiple npi flag
- N
- Ccn
- 148179
- Associate id
- 7214075639
- Organization name
- ILLINOIS HEALTHCARE SERVICES, LLC
- Doing business as name
- ILLINOIS HEALTHCARE SERVICES INC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5940 W TOUHY AVE
- Address line 2
- STE 130
- City
- NILES
- State
- IL
- Zip code
- 607144642
- Practice location type
- HHA BRANCH