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NPI Code Detail

MEDICARE: PROVENA HOME HEALTH INC

MEDICARE: PROVENA HOME HEALTH INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251F00000XHome Infusion Agency1010260IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104523557OTHERILBLUE SHIELD

General Provider Information

NPI Number : 1205885407
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVENA HOME HEALTH INC
Provider Business Mailing Address
First Line : 9223 WEST ST FRANCIS ROAD
Second Line :
City : FRANKFORT
State : IL
Zip : 60423-8334
Country : US
Telephone Number : 815-806-2300
Fax Number : 815-806-0409
Provider Business Practice Location Address
First Line : 77 NORTH AIRLITE
Second Line : MOB1 SUITE 120
City : ELGIN
State : IL
Zip : 60123-4912
Country : US
Telephone Number : 847-931-5553
Fax Number : 847-622-2055
Authorized Official
Title or Position : PRESIDENT CEO
Name : MRS. MARGARET C GLEASON
Credential : RN MSN
Telephone Number : 815-806-2364
Provider Enumeration Date : 05/08/2006
Last Update Date : 08/22/2020

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Directions to “PROVENA HOME HEALTH INC ” Practice Location

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