Provider Demographics
NPI:1730115130
Name:ADDUS HEALTHCARE (NEVADA), INC.
Entity Type:Organization
Organization Name:ADDUS HEALTHCARE (NEVADA), INC.
Other - Org Name:
Other - Org Type:
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 PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7486
Mailing Address - Country:US
Mailing Address - Phone:847-303-5300
Mailing Address - Fax:847-303-5376
Practice Address - Street 1:1641 E FLAMINGO RD
Practice Address - Street 2:SUITE 11
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5257
Practice Address - Country:US
Practice Address - Phone:702-435-5030
Practice Address - Fax:702-435-5099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3785HHA-3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297116Medicare Oscar/Certification