1093960635 NPI number — ADVOCATE HOME CARE PRODUCTS, INC

Table of content: (NPI 1093960635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093960635 NPI number — ADVOCATE HOME CARE PRODUCTS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVOCATE HOME CARE PRODUCTS, 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:
1093960635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2311 W 22ND ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-572-1232
Provider Business Mailing Address Fax Number:
630-368-5912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 TERRACE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNDELEIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60060-3826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-970-3200
Provider Business Practice Location Address Fax Number:
847-970-9287
Provider Enumeration Date:
11/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KEEFE
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-638-5907

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1617625 . This is a "BLUE CROSS BLUE SHIELD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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