Provider Demographics
NPI:1174274237
Name:INTERIM HEALTHCARE OF DOWNSTATE ILLINOIS
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF DOWNSTATE ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:309-696-3822
Mailing Address - Street 1:1223 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1936
Mailing Address - Country:US
Mailing Address - Phone:309-296-0056
Mailing Address - Fax:
Practice Address - Street 1:1223 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1936
Practice Address - Country:US
Practice Address - Phone:309-296-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care