Organization
ILLINOIS LIV, LLC
Active
Other names
Northwestern Illinois Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS GACHASSIN III (EXECUTIVE VICE PRESIDENT)
(337) 233-1307
Entity
Organization
Contact information
Practice address
7017 JOHN DEERE PKWY STE 2A, MOLINE, IL 61265-8037
(309) 623-4022
(309) 792-7296
Mailing address
PO BOX 51266, LAFAYETTE, LA 70505-1266
(337) 233-1307
(337) 233-5764
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0974923
—
IA
05
—
421436658004
—
IL
Enumeration date
03/07/2014
Last updated
02/07/2023
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