1114943750 NPI number — ADDUS HEALTHCARE INC

Table of content: (NPI 1114943750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114943750 NPI number — ADDUS HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADDUS HEALTHCARE 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:
Provider Other Organization Name Type Code:
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:
1114943750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 WARRENVILLE RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-3400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
823 W MAIN ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-863-1834
Provider Business Practice Location Address Fax Number:
253-863-1663
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
DARBY
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP, CHIEF STRATEGY OFFICER
Authorized Official Telephone Number:
630-296-3443

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 187837 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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