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General NPI Number Information
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NPI Number | 1639421654
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Entity Type | Organization
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Legal Business Name | PINK LADIES HOME HEALTHCARE INC.
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 1107 W MAIN ST
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City | OTTAWA
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State | IL
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Zip | 61350-2624
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Country | US
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Telephone | 815-200-2283
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 W MAIN ST
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City | OTTAWA
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State | IL
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Zip | 61350
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Country | US
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Telephone | 815-431-6000
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Fax | 815-324-5000
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHEILA DENAULT
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Credential | CNA
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Telephone | 815-200-2283
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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 | 68690056
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License Number State | IL
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