MEDICARE: PF DEVELOPMENT 5, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1011124	IL

General Provider Information

NPI Number	:	1083976617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PF DEVELOPMENT 5, LLC

Provider Business Mailing Address
First Line	:	6330 SPRINT PKWY STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 W US HIGHWAY 20
Second Line	:	STE 200
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-8818
Country	:	US
Telephone Number	:	847-683-9090
Fax Number	:	847-683-9094

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	847-683-9090

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	09/02/2022

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Directions to “PF DEVELOPMENT 5, LLC ” Practice Location

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