=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891747986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AESQUIVEL PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9721 PRAIRIE AVE
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-922-8100
-----------------------------------------------------
Fax | 219-922-1700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9721 PRAIRIE AVE
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-922-8100
-----------------------------------------------------
Fax | 219-922-1700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMDON
-----------------------------------------------------
Name | MRS. MARICLAIRE A SILVERMAN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 219-922-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 15-7558
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------