=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497992580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GL HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2009
-----------------------------------------------------
Last Update Date | 11/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1315 MACOM DR STE 104
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-9360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-535-9482
-----------------------------------------------------
Fax | 708-535-9483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1315 MACOM DR STE 104
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-9360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-535-9482
-----------------------------------------------------
Fax | 708-535-9483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSING
-----------------------------------------------------
Name | MS. MARY CYDEL MALLARI
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 708-535-9482
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010993
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------