Healthcare Provider Details

I. General information

NPI: 1205110855
Provider Name (Legal Business Name): PRESENCE HEALTHCCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N SHERIDAN RD STE 506
CHICAGO IL
60657-6156
US

IV. Provider business mailing address

62311 COLLECTION CENTER DR
CHICAGO IL
60693-0623
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-7680
  • Fax: 773-472-7697
Mailing address:
  • Phone: 630-914-2417
  • Fax: 630-914-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REINHOLD LLERENA
Title or Position: CEO
Credential: MD
Phone: 224-273-8908