1295967560 NPI number — FIRST VENTURE HOME HEALTHCARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295967560 NPI number — FIRST VENTURE HOME HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST VENTURE HOME 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:
1295967560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 S. WILKE RD
Provider Second Line Business Mailing Address:
SUITE 204-D
Provider Business Mailing Address City Name:
ARUNGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60005-1533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-506-9767
Provider Business Mailing Address Fax Number:
847-506-9769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 S. WILKE RD.
Provider Second Line Business Practice Location Address:
SUITE 204-D
Provider Business Practice Location Address City Name:
ARUNGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-1533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-506-9767
Provider Business Practice Location Address Fax Number:
847-506-9769
Provider Enumeration Date:
08/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
QUINTO
Authorized Official First Name:
JENNY
Authorized Official Middle Name:
LINGAN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
847-506-9767

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1011050 , 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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