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General NPI Number Information
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NPI Number | 1144653684
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Entity Type | Organization
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Legal Business Name | E-GEN LLC
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 610 HERITAGE CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-3393
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Country | US
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Telephone | 630-560-1169
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Fax | 630-560-1105
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Provider Business Mailing Address
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Address Line | 610 HERITAGE CT
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City | NAPERVILLE
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State | IL
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Zip | 60565-3393
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Country | US
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Telephone | 630-560-1169
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Fax | 630-560-1105
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW SIMONTON
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Credential |
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Telephone | 331-202-7697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 4000423
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3001024
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License Number State | IL
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