1538113535 NPI number — PEKIN PROHEALTH INC.

Table of content: (NPI 1538113535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538113535 NPI number — PEKIN PROHEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEKIN PROHEALTH INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROCARE HOME HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538113535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1416 N 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEKIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61554-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-347-4663
Provider Business Mailing Address Fax Number:
309-347-5127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 ILLINOIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENDOTA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61342-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-539-6506
Provider Business Practice Location Address Fax Number:
815-539-6708
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYNES
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
309-347-4663

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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