Provider Demographics
NPI:1538180443
Name:INTERIM HEALTHCARE, INC.
Entity type:Organization
Organization Name:INTERIM HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UMANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-858-2852
Mailing Address - Street 1:1601 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2883
Mailing Address - Country:US
Mailing Address - Phone:954-858-2871
Mailing Address - Fax:954-858-2710
Practice Address - Street 1:10 W 35TH ST
Practice Address - Street 2:SUITE 16D8-1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3717
Practice Address - Country:US
Practice Address - Phone:312-328-6507
Practice Address - Fax:312-328-1146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERIM HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1007962251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========006Medicaid