# STATE OF IL DEPT OF HUMAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104361633
- **Authorized official:** MRS. ELIZABETH RITTENBACHER LPN (LPN)
- **Authorized official phone:** (815) 426-6299

## Contact information

- **Practice address:** 1617 W JEFFERSON ST, JOLIET, IL 60435-6724
- **Practice address phone:** (815) 730-4231
- **Mailing address:** 3334 N 12,000 W ROAD, BONFIELD, IL 60913-7383
- **Mailing address phone:** (815) 426-6299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 1744428 | IL | Yes |

## Other

- **Enumeration date:** 12/19/2016
- **Last updated:** 12/19/2016