NPIMap

Organization Active NPI

Home Clinic LLC

  • Physical Therapy Clinic/Center
  • Buckley, IL
National Provider Identifier
1619436904
Registry record updated Mar 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
HOME CLINIC LLC
Practice address
109 S 3Rd St
Buckley, IL 60918-7044
Phone
(708) 227-8403
NPI assigned
Mar 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2019

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

Authorized official

Name
Dr. Shane T Stachura, PT, DPT, CLT
Title
Member Manager
Phone
(708) 227-8403

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

109 S 3Rd St
Buckley, IL 60918-7044

Mailing address

PO Box 24
Buckley, IL 60918-0024
Phone (708) 227-8403

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552608000000",
    "number": "1619436904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24",
            "city": "BUCKLEY",
            "state": "IL",
            "postal_code": "609180024",
            "telephone_number": "708-227-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S 3RD ST",
            "city": "BUCKLEY",
            "state": "IL",
            "postal_code": "609187044",
            "telephone_number": "708-227-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-15",
        "last_updated": "2019-03-15",
        "status": "A",
        "authorized_official_last_name": "STACHURA",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "708-227-8403",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, CLT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buckley, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; 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.