Healthcare Provider Details

I. General information

NPI: 1245739168
Provider Name (Legal Business Name): ENHAUS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEADOWVIEW CTR STE 402
KANKAKEE IL
60901-2061
US

IV. Provider business mailing address

70 MEADOWVIEW CTR STE 402
KANKAKEE IL
60901-2061
US

V. Phone/Fax

Practice location:
  • Phone: 855-364-2878
  • Fax: 815-401-7629
Mailing address:
  • Phone: 855-364-2878
  • Fax: 815-401-7629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3001576
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number3001576
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number3001576
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number3001576
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number3001576
License Number StateIL

VIII. Authorized Official

Name: BRIAN JOSEPH LERIGER
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 855-364-4287