Healthcare Provider Details

I. General information

NPI: 1447818166
Provider Name (Legal Business Name): ULTIMUS MANAGEMENT-IL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S SPRING ST
SPRINGFIELD IL
62704-2725
US

IV. Provider business mailing address

132 PEARLCROFT RD
CHERRY HILL NJ
08034-3334
US

V. Phone/Fax

Practice location:
  • Phone: 609-509-2388
  • Fax:
Mailing address:
  • Phone: 609-509-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD AUSTIN DUUS
Title or Position: CFO
Credential: CPA
Phone: 609-509-2388