Healthcare Provider Details

I. General information

NPI: 1790689701
Provider Name (Legal Business Name): ANTERO B. GENTICA BSN-RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

4343 N CLARENDON AVE APT 1106
CHICAGO IL
60613-1580
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2596
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number041.277340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: