Illinois Liv, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

ILLINOIS LIV, LLC

Doing business as

Northwestern Illinois Home Health

Practice address

7017 John Deere Pkwy Ste 2a
Moline, IL 61265-8037

Phone

(309) 623-4022

Fax

(309) 792-7296

NPI assigned

Mar 7, 2014

Last updated

Feb 7, 2023By 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. Nicholas Gachassin III

Title

Executive Vice President

Phone

(337) 233-1307

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Northwestern Illinois Home Health Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477979078. Details of each certification follow.

• CCN 147619 Home health agency · Active · Details

Home health agency certification: CCN 147619

Legal name

ILLINOIS LIV, LLC

Doing business as

NORTHWESTERN ILLINOIS HOME HEALTH

Certification status

Active

Provider type (POS)

Home health agency

Participating since

May 19, 1995

Last certification

Feb 21, 2020

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Feb 13, 2014 in IL

Enrollment address

7017 John Deere Pkwy
Unit 2a
Moline, IL 61265-8072

Listed as

Northwestern Illinois Home HealthCCN 147619 · All quality measures

Overall star rating

3.5 of 5

Ownership

Proprietary

Certified

May 19, 1995

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Physical therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• LHCG Xxxvii, LLC

  dba LHC-Illinois Home Health Care

  • Home Health Agency
  • Marion, IL
  • NPI 1740527407

  Illinois Health Care Group LLC

  CMS ownership
• LHCG Xxxvii, LLC

  dba LHC-Illinois Home Health Care

  • Home Health Agency
  • Flossmoor, IL
  • NPI 1801133533

  Illinois Health Care Group LLC

  CMS ownership
• LHCG Xxxvii, LLC

  dba LHC-Illinois Home Health Care

  • Home Health Agency
  • Champaign, IL
  • NPI 1841537503

  Illinois Health Care Group LLC

  CMS ownership

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Jean E Wardlow, MD

  • Internal Medicine Physician
  • Moline, IL
  • NPI 1316984313

  Home health agency

  Care Compare affiliation
• Mary Ann Defrance, MD

  • Family Medicine Physician
  • Bettendorf, IA
  • NPI 1184244584

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1477979078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51266",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705051266",
            "telephone_number": "337-233-1307",
            "fax_number": "337-233-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7017 JOHN DEERE PKWY STE 2A",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658037",
            "telephone_number": "309-623-4022",
            "fax_number": "309-792-7296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS LIV, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "GACHASSIN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0974923",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421436658004",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwestern Illinois Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northwestern Illinois Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in Moline, IL
• Providers in Moline, IL by specialty
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.