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General NPI Number Information
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NPI Number | 1205885407
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Entity Type | Organization
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Legal Business Name | PROVENA HOME HEALTH INC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 77 NORTH AIRLITE MOB1 SUITE 120
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City | ELGIN
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State | IL
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Zip | 60123-4912
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Country | US
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Telephone | 847-931-5553
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Fax | 847-622-2055
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Provider Business Mailing Address
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Address Line | 9223 WEST ST FRANCIS ROAD
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City | FRANKFORT
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State | IL
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Zip | 60423-8334
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Country | US
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Telephone | 815-806-2300
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Fax | 815-806-0409
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MRS. MARGARET C GLEASON
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Credential | RN MSN
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Telephone | 815-806-2364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 1010260
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License Number State | IL
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