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General NPI Number Information
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NPI Number | 1679973887
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Entity Type | Organization
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Legal Business Name | PF DEVELOPMENT 5, LLC
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 4430 MANCHESTER DR SUITE G-1
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City | ROCKFORD
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State | IL
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Zip | 61109-8316
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Country | US
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Telephone | 815-397-8930
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Fax | 815-397-8968
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Provider Business Mailing Address
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Address Line | 4430 MANCHESTER DR SUITE G-1
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City | ROCKFORD
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State | IL
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Zip | 61109-8316
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Country | US
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Telephone | 815-397-8930
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Fax | 815-397-8968
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | RUTH SCHWARTZ
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Credential |
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Telephone | 913-814-2288
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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 | 1011600
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License Number State | IL
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