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General NPI Number Information
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NPI Number | 1518116771
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Entity Type | Organization
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Legal Business Name | JENUINE HEALTHCARE
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 2111 SILVERSTONE DR
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City | CARPENTERSVILLE
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State | IL
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Zip | 60110-1197
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Country | US
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Telephone | 630-229-7370
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 SILVERSTONE DR
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City | CARPENTERSVILLE
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State | IL
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Zip | 60110-1197
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Country | US
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Telephone | 630-229-7370
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JONATHAN EDWARD MARTIN
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Credential |
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Telephone | 630-229-7370
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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 | 2008-N1174
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License Number State | IL
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