MEDICARE: DANE ENTERPRISE 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
1	251E00000X	Home Health Agency		IL

General Provider Information

NPI Number	:	1710140348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANE ENTERPRISE INC.

Provider Business Mailing Address
First Line	:	1250 S GROVE AVE STE 200
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-5011
Country	:	US
Telephone Number	:	847-304-0123
Fax Number	:	847-382-1787

Provider Business Practice Location Address
First Line	:	1250 S GROVE AVE STE 200
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-5011
Country	:	US
Telephone Number	:	847-304-0123
Fax Number	:	847-382-1787

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	MR. DIEGO URIBE
Credential	:
Telephone Number	:	847-304-0123

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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Directions to “DANE ENTERPRISE INC. ” Practice Location

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