MEDICARE: ADDUS HEALTHCARE, INC.

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	6759	NM
2	251E00000X	Home Health Agency	85R76	NM
3	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6759	OTHER		OPERATORS NUMBER
2	D3597	OTHER		PROVIDERS NUMBER

General Provider Information

NPI Number	:	1619930161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDUS HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	2300 WARRENVILLE RD STE 100
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1717
Country	:	US
Telephone Number	:	630-296-3400
Fax Number	:	630-487-2713

Provider Business Practice Location Address
First Line	:	19 INDUSTRIAL PARK ROAD
Second Line	:	STE, C
City	:	SANTA FE
State	:	NM
Zip	:	87506
Country	:	US
Telephone Number	:	505-753-2284
Fax Number	:	855-893-0646

Authorized Official
Title or Position	:	EVP, CHIEF STRATEGY OFFICER
Name	:	MR. DARBY ANDERSON
Credential	:
Telephone Number	:	630-296-3591

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	10/05/2021

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Directions to “ADDUS HEALTHCARE, INC. ” Practice Location

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