Healthcare Provider Details

I. General information

NPI: 1821198946
Provider Name (Legal Business Name): PRESENCE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 E DEMPSTER ST
DES PLAINES IL
60016-4839
US

IV. Provider business mailing address

2380 E DEMPSTER ST
DES PLAINES IL
60016-4839
US

V. Phone/Fax

Practice location:
  • Phone: 847-493-4835
  • Fax: 847-493-4923
Mailing address:
  • Phone: 847-493-4835
  • Fax: 847-493-4923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL J GORDONG
Title or Position: CEO/PRESIDENT
Credential:
Phone: 708-478-7911