Provider Demographics
NPI:1083837637
Name:PROVIDE A CARE LLC
Entity Type:Organization
Organization Name:PROVIDE A CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMENCITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-326-6860
Mailing Address - Street 1:500 E HIGGINS RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1400
Mailing Address - Country:US
Mailing Address - Phone:773-326-6860
Mailing Address - Fax:847-690-1539
Practice Address - Street 1:500 E HIGGINS RD
Practice Address - Street 2:SUITE 207
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1400
Practice Address - Country:US
Practice Address - Phone:773-326-6860
Practice Address - Fax:847-690-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010653251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148017Medicare Oscar/Certification