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General NPI Number Information
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NPI Number | 1427481720
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Entity Type | Organization
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Legal Business Name | CDONNAN ENTERPRISES LLC
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Dates
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Enumeration Date | 08/10/2013
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Last Update Date | 08/10/2013
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Provider Practice Location Address
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Address Line | 9212 BLUE SAGE RD
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City | CLINTON
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State | IL
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Zip | 61727-9454
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Country | US
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Telephone | 217-935-4357
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 461
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City | CLINTON
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State | IL
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Zip | 61727-0461
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Country | US
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Telephone | 217-935-4357
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRISTOPHER GENE DONNAN
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Credential |
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Telephone | 217-935-4357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3000229
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License Number State | IL
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