1942259346 NPI number — PRESENCE HOME CARE

Table of content: (NPI 1942259346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942259346 NPI number — PRESENCE HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESENCE HOME CARE
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:
PRESENCE HOME CARE - ELGIN
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:
1942259346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9223 W ST FRANCIS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60423-8334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-806-2300
Provider Business Mailing Address Fax Number:
815-806-0409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
799 S MCLEAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-931-5553
Provider Business Practice Location Address Fax Number:
847-622-2055
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
708-478-7911

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1010260 , 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)

  • Identifier: 50150 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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