Healthcare Provider Details

I. General information

NPI: 1447756663
Provider Name (Legal Business Name): VENUS PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 COMFORT DR
MARION IL
62959-4927
US

IV. Provider business mailing address

442 COMFORT DR
MARION IL
62959-4927
US

V. Phone/Fax

Practice location:
  • Phone: 618-364-0482
  • Fax: 618-364-0484
Mailing address:
  • Phone: 618-364-0482
  • Fax: 618-364-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number5105215
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number5105215
License Number StateIL

VIII. Authorized Official

Name: MR. SRINIVAS GUNDALA
Title or Position: OWNER/CEO
Credential:
Phone: 618-303-2716