Organization
ICG HOME HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANIE DIONNE JOHNSON REGISTERED NURSE (HOME HEALTH RN)
(708) 369-1329
Entity
Organization
Contact information
Practice address
4508 CAMDEN CT, RICHTON PARK, IL 60471-1147
(708) 369-1329
Mailing address
4508 CAMDEN CT, RICHTON PARK, IL 60471-1147
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
041379716
IL
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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