Provider Demographics
NPI:1104181932
Name:PANOPTIC HEALTH SERVICE INC
Entity Type:Organization
Organization Name:PANOPTIC HEALTH SERVICE INC
Other - Org Name:PANOPTIC HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-513-3298
Mailing Address - Street 1:1802 N DIVISION ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3104
Mailing Address - Country:US
Mailing Address - Phone:815-513-3298
Mailing Address - Fax:
Practice Address - Street 1:1802 N DIVISION ST STE 202
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3104
Practice Address - Country:US
Practice Address - Phone:815-513-3298
Practice Address - Fax:815-513-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011613251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health