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Organization

APOSTOLIC CHRISTIAN HOME OF ROANOKE ILLINOIS INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RICHARD D ISAIA (ADMINISTRATOR)
(309) 923-2071
Entity
Organization

Contact information

Practice address
1102 W RANDOLPH ST, ROANOKE, IL 61561-7528
(309) 923-2071
(309) 923-7919
Mailing address
PO BOX 530, ROANOKE, IL 61561-0530
(309) 923-2071
(309) 923-7919

Taxonomy

Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0021493
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0021493
IL
Enumeration date
09/02/2016
Last updated
01/24/2017
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