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General NPI Number Information
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NPI Number | 1427292127
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Entity Type | Organization
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Legal Business Name | WILEY ENTERPRISES INC. DBA AS COMFORT KEEPERS #526
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | #3 LAWRENCE SQUARE
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City | SPRINGFIELD
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State | IL
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Zip | 62704
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Country | US
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Telephone | 217-744-2226
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Fax | 217-744-2228
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Provider Business Mailing Address
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Address Line | 3 LAWRENCE SQ
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City | SPRINGFIELD
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State | IL
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Zip | 62704-8215
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Country | US
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Telephone | 217-744-2226
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Fax | 217-744-2228
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. JASON P. WILEY
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Credential |
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Telephone | 217-744-2226
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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 | 3000357
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License Number State | IL
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