Organization
IJV HOME VISITS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISABEL F FAIRCLOTH NP (PRESIDENT)
(312) 714-7712
Entity
Organization
Contact information
Practice address
5250 OLD ORCHARD RD, APT 1501, SKOKIE, IL 60077-4460
(312) 714-7712
Mailing address
5250 OLD ORCHARD RD, APT 1501, SKOKIE, IL 60077-4460
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
209005626
IL
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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