1366405227 NPI number — ADDUS HEALTHCARE INC

Table of content: (NPI 1366405227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366405227 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:
6
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:
1366405227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 WARRENVILLE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-3400
Provider Business Mailing Address Fax Number:
630-487-2713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6128 W SAHARA AVE
Provider Second Line Business Practice Location Address:
ROOM A
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-3051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-359-3105
Provider Business Practice Location Address Fax Number:
702-598-2041
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUMARICH
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
NATIONAL CONTRACTS
Authorized Official Telephone Number:
630-296-3400

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 5427PCS8 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100505778 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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