Healthcare Provider Details

I. General information

NPI: 1679959555
Provider Name (Legal Business Name): AGING CARE CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W HARRIS AVE
LA GRANGE IL
60525-2336
US

IV. Provider business mailing address

111 W HARRIS AVE
LA GRANGE IL
60525-2336
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-1323
  • Fax: 708-354-0282
Mailing address:
  • Phone: 708-354-1323
  • Fax: 708-354-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. DEBRA VERSCHELDE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 708-354-1323