Interactive Healthcare of Central Illinois

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1011482 Issued in IL

Legal business name

INTERACTIVE HEALTHCARE OF CENTRAL ILLINOIS

Practice address

1701 S 1St Ave
Suite 503
Maywood, IL 60153-2442

Phone

(708) 344-7930

Fax

(708) 344-7932

NPI assigned

Jun 15, 2011

Last updated

Jun 15, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Gossman

Title

President

Phone

(708) 344-7930

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308096000000",
    "number": "1033404363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 S 1ST AVE",
            "address_2": "SUITE 503",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532442",
            "telephone_number": "708-344-7930",
            "fax_number": "708-344-7932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 S 1ST AVE",
            "address_2": "SUITE 503",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532442",
            "telephone_number": "708-344-7930",
            "fax_number": "708-344-7932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERACTIVE HEALTHCARE OF CENTRAL ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-15",
        "last_updated": "2011-06-15",
        "status": "A",
        "authorized_official_last_name": "GOSSMAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-344-7930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.