Provider Demographics
NPI:1619480191
Name:PASSIONATE PRIVATE DUTY, LLC
Entity Type:Organization
Organization Name:PASSIONATE PRIVATE DUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-975-3950
Mailing Address - Street 1:2401 W US HIGHWAY 20 STE 202
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-8819
Mailing Address - Country:US
Mailing Address - Phone:847-975-3950
Mailing Address - Fax:847-972-0600
Practice Address - Street 1:2401 W US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-8818
Practice Address - Country:US
Practice Address - Phone:847-975-3950
Practice Address - Fax:847-792-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000558251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care