=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407658032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURPOSECARE OF ILLINOIS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2025
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 N NORTHWEST HWY
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-3343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-698-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 N NORTHWEST HWY
-----------------------------------------------------
City | PARK RIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60068-3343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-698-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RICHARD KELLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-763-6945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------