Healthcare Provider Details

I. General information

NPI: 1215706494
Provider Name (Legal Business Name): ABODE CARE PARTNERS LTC VB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 COMPASS RD STE 100
GLENVIEW IL
60026-8004
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY
LOUISVILLE KY
40222-5186
US

V. Phone/Fax

Practice location:
  • Phone: 800-805-6555
  • Fax: 855-316-2999
Mailing address:
  • Phone: 502-394-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGIE MATTINGLY
Title or Position: MGR PROVIDER ENROLLMENT
Credential:
Phone: 502-394-2100