Healthcare Provider Details

I. General information

NPI: 1639591985
Provider Name (Legal Business Name): ABRASSART VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COMMERCE DR SUITE 275
CRYSTAL LAKE IL
60014-3539
US

IV. Provider business mailing address

333 COMMERCE DR SUITE 275
CRYSTAL LAKE IL
60014-3539
US

V. Phone/Fax

Practice location:
  • Phone: 847-459-1502
  • Fax:
Mailing address:
  • Phone: 847-459-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3001115
License Number StateIL

VIII. Authorized Official

Name: DEAN ABRASSART
Title or Position: PRESIDENT
Credential:
Phone: 815-459-1502