1003879552 NPI number — ADDUS HEALTHCARE

Table of content: (NPI 1003879552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003879552 NPI number — ADDUS HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADDUS HEALTHCARE
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:
PREMIER HEALTH CONNECTION
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:
1003879552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 S PLUM GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-303-5300
Provider Business Mailing Address Fax Number:
847-303-5376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 SUTTER ST
Provider Second Line Business Practice Location Address:
STE 360
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-671-4100
Provider Business Practice Location Address Fax Number:
925-356-2889
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUMARICH
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
NATIONAL CONTRACTS
Authorized Official Telephone Number:
847-303-5300

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 020000226 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HHA70123G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com