Provider Demographics
NPI:1841381738
Name:PRESENCE HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:PRESENCE HEALTHCARE SERVICES
Other - Org Name:PRESENCE HOME CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-478-7911
Mailing Address - Street 1:100 N. RIVER ROAD
Mailing Address - Street 2:SUITE 122S
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1209
Mailing Address - Country:US
Mailing Address - Phone:847-581-0808
Mailing Address - Fax:847-410-4917
Practice Address - Street 1:100 N. RIVER ROAD
Practice Address - Street 2:SUITE 122S
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1209
Practice Address - Country:US
Practice Address - Phone:847-581-0808
Practice Address - Fax:847-410-4917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESURRECTION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540141123336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-008Medicaid