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General NPI Number Information
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NPI Number | 1922733302
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Entity Type | Organization
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Legal Business Name | PANOPTIC HOME CARE LLC
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 1802 N DIVISION ST STE 202
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City | MORRIS
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State | IL
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Zip | 60450-3104
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Country | US
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Telephone | 815-513-3298
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Fax | 815-513-5446
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Provider Business Mailing Address
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Address Line | 1802 N DIVISION ST STE 202
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City | MORRIS
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State | IL
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Zip | 60450-3104
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Country | US
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Telephone | 815-513-3298
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Fax | 815-513-5446
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Authorized Official
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Title or Position | PRESIDENT
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Name | GERALD MERTES III
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Credential |
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Telephone | 815-513-3298
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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 |
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License Number State |
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