Healthcare Provider Details

I. General information

NPI: 1700964855
Provider Name (Legal Business Name): AVESENA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E LAKE ST SUITE 108
ADDISON IL
60101-2888
US

IV. Provider business mailing address

221 E LAKE ST SUITE 108
ADDISON IL
60101-2888
US

V. Phone/Fax

Practice location:
  • Phone: 630-833-2486
  • Fax: 630-833-2487
Mailing address:
  • Phone: 630-833-2486
  • Fax: 630-833-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierIL1010340
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerSTATE ID

VIII. Authorized Official

Name: MOHAMMAD ASLAM
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 630-833-2486