1588655468 NPI number — VNA HOME HEALTH OF ILLINOIS LTD

Table of content: (NPI 1588655468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588655468 NPI number — VNA HOME HEALTH OF ILLINOIS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VNA HOME HEALTH OF ILLINOIS LTD
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:
VNA HEALTHTRENDS SOUTH
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:
1588655468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HOWARD AVE
Provider Second Line Business Mailing Address:
SUITE 248
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60018-5906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-676-3931
Provider Business Mailing Address Fax Number:
847-803-0821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 N CONVENT ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
BOURBONNAIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60914-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-908-1606
Provider Business Practice Location Address Fax Number:
815-932-3643
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENEGHAN
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
866-676-3931

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1009513 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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