Provider Demographics
NPI:1487325841
Name:IGBINOVIA, EKAETTE PEACE
Entity type:Individual
Prefix:
First Name:EKAETTE
Middle Name:PEACE
Last Name:IGBINOVIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 RENAISSANCE CIR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-5891
Mailing Address - Country:US
Mailing Address - Phone:708-301-0800
Mailing Address - Fax:
Practice Address - Street 1:12600 RENAISSANCE CIR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-5891
Practice Address - Country:US
Practice Address - Phone:708-301-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility