Provider Demographics
NPI:1548420763
Name:PROMEDEX, LLC
Entity Type:Organization
Organization Name:PROMEDEX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:PRESSIE
Authorized Official - Middle Name:MANARES
Authorized Official - Last Name:CAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-653-9976
Mailing Address - Street 1:1185 COBBLE HILL CT
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-6913
Mailing Address - Country:US
Mailing Address - Phone:224-653-9976
Mailing Address - Fax:224-653-9978
Practice Address - Street 1:1185 COBBLE HILL CT
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-6913
Practice Address - Country:US
Practice Address - Phone:224-653-9976
Practice Address - Fax:224-653-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041153453314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility