Icg Home Health

Organization Active NPI Nursing Facility/Intermediate Care Facility · Richton Park, IL

NPI 1386094068 · NPPES record last updated Jun 14, 2016

Key facts

NPI
1386094068
Entity type
Organization (NPI type 2)
Primary specialty
Nursing Facility/Intermediate Care Facility 313M00000X
License
041379716 (IL)
Legal business name
ICG HOME HEALTH
Practice address
4508 Camden CT
Richton Park, IL 60471-1147
Phone
(708) 369-1329
NPI assigned
Jun 14, 2016
Organization subpart
No

Authorized official

Name
Tiffanie Dionne Johnson, REGISTERED NURSE
Title
Home Health RN
Phone
(708) 369-1329

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 041379716 IL Yes

Addresses

Primary practice location

4508 Camden CT
Richton Park, IL 60471-1147

Mailing address

4508 Camden CT
Richton Park, IL 60471-1147

Other providers in Richton Park, IL

All providers in Richton Park, IL · Nursing Facility/Intermediate Care Facility in Illinois

Sources for this page

Verify at the official NPI Registry.