Healthcare Provider Details

I. General information

NPI: 1073448361
Provider Name (Legal Business Name): AN HONORABLE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 N DOUGLAS ST
PEORIA IL
61606-1304
US

IV. Provider business mailing address

1209 N DOUGLAS ST
PEORIA IL
61606-1304
US

V. Phone/Fax

Practice location:
  • Phone: 773-245-6737
  • Fax:
Mailing address:
  • Phone: 773-245-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. QUINTINA HONORABLE
Title or Position: CNA
Credential:
Phone: 309-356-4051