1750521118 NPI number — AUTUMN HOME CARE OF NAPERVILLE, INC

Table of content: (NPI 1750521118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750521118 NPI number — AUTUMN HOME CARE OF NAPERVILLE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTUMN HOME CARE OF NAPERVILLE, 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:
AUTUMN HOME CARE
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:
1750521118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3655 N ALPINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61114-7351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-636-0860
Provider Business Mailing Address Fax Number:
815-636-0866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3655 N ALPINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61114-7351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-636-0860
Provider Business Practice Location Address Fax Number:
815-636-0866
Provider Enumeration Date:
02/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OMLAND
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
941-957-0952

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1011093 , 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)





Copyright © 2007-2024 www.npivalidator.com