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General NPI Number Information
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NPI Number | 1104181932
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Entity Type | Organization
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Legal Business Name | PANOPTIC HEALTH SERVICE INC
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 1802 N DIVISION ST STE 202
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City | MORRIS
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State | IL
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Zip | 60450-3104
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Country | US
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Telephone | 815-513-3298
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Fax | 815-513-5446
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Provider Business Mailing Address
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Address Line | 1802 N DIVISION ST STE 202
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City | MORRIS
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State | IL
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Zip | 60450-3104
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Country | US
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Telephone | 815-513-3298
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GERALD MERTES
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Credential |
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Telephone | 815-513-3298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1011613
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License Number State | IL
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