Provider Demographics
NPI:1245848613
Name:SHS OF FOX VALLEY, LLC
Entity type:Organization
Organization Name:SHS OF FOX VALLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-937-4246
Mailing Address - Street 1:328 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1949
Mailing Address - Country:US
Mailing Address - Phone:630-761-9750
Mailing Address - Fax:
Practice Address - Street 1:328 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1949
Practice Address - Country:US
Practice Address - Phone:630-761-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001936OtherHOME SERVICES LIC.