Healthcare Provider Details

I. General information

NPI: 1811178924
Provider Name (Legal Business Name): ADDUS HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E LOUTHER ST #306
CARLISLE PA
17013-2657
US

IV. Provider business mailing address

2300 WARRENVILLE RD SUITE 100
DOWNERS GROVE IL
60515-1765
US

V. Phone/Fax

Practice location:
  • Phone: 717-245-9006
  • Fax: 855-893-0655
Mailing address:
  • Phone: 630-296-3400
  • Fax: 630-487-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100728460-0004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1007284600007
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MS. DIANE KUMARICH
Title or Position: NATIONAL CONTRACTS
Credential: RN, MS, MBA
Phone: 630-296-3400