Provider Demographics
NPI:1447626726
Name:INSTITUTE OF FAMILY CARE
Entity type:Organization
Organization Name:INSTITUTE OF FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-608-3041
Mailing Address - Street 1:809 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-2951
Mailing Address - Country:US
Mailing Address - Phone:815-608-3041
Mailing Address - Fax:
Practice Address - Street 1:809 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-2951
Practice Address - Country:US
Practice Address - Phone:815-608-3041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172A00000X, 251B00000X, 251E00000X, 374U00000X, 376J00000X
302R00000X, 343900000X, 347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No347B00000XTransportation ServicesBusGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty