Healthcare Provider Details

I. General information

NPI: 1477549509
Provider Name (Legal Business Name): PRESENCE LIFE CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N ENTRANCE AVE
KANKAKEE IL
60901-2026
US

IV. Provider business mailing address

18927 HICKORY CREEK DR STE 300
MOKENA IL
60448-8652
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-4506
  • Fax: 815-939-4761
Mailing address:
  • Phone: 708-478-6382
  • Fax: 708-478-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIL

VIII. Authorized Official

Name: KELLIE GRONEFELD
Title or Position: COO
Credential:
Phone: 314-729-3500