Individual
LATISHA MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2929 N MAIN ST, ROCKFORD, IL 61103-3199
(779) 210-1293
Mailing address
2929 N MAIN ST, ROCKFORD, IL 61103-3199
(779) 210-1293
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
929929929
HOME HEALTH CARE
IL
Enumeration date
04/08/2019
Last updated
10/05/2021
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