Healthcare Provider Details

I. General information

NPI: 1841584679
Provider Name (Legal Business Name): ADAMS HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 19TH ST SUITE 103
ROCK ISLAND IL
61201-8018
US

IV. Provider business mailing address

100 19TH ST SUITE 103
ROCK ISLAND IL
61201-8018
US

V. Phone/Fax

Practice location:
  • Phone: 309-786-9982
  • Fax: 309-786-3552
Mailing address:
  • Phone: 309-786-9982
  • Fax: 309-786-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4000149
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000261
License Number StateIL

VIII. Authorized Official

Name: MRS. KIRSTEN MAVOURNEEN ADAMS
Title or Position: PRESIDENT / CEO
Credential:
Phone: 309-786-9982