Provider Demographics
NPI:1003879552
Name:ADDUS HEALTHCARE
Entity Type:Organization
Organization Name:ADDUS HEALTHCARE
Other - Org Name:PREMIER HEALTH CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL CONTRACTS
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMARICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, MBA
Authorized Official - Phone:847-303-5300
Mailing Address - Street 1:2401 S PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067
Mailing Address - Country:US
Mailing Address - Phone:847-303-5300
Mailing Address - Fax:847-303-5376
Practice Address - Street 1:1800 SUTTER ST
Practice Address - Street 2:STE 360
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-671-4100
Practice Address - Fax:925-356-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251F00000X, 251J00000X
CA020000226251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70123GMedicaid
CA057511Medicare Oscar/Certification