Provider Demographics
NPI:1841584679
Name:ADAMS HOMECARE, LLC
Entity Type:Organization
Organization Name:ADAMS HOMECARE, LLC
Other - Org Name:LIGHTHOUSE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:MAVOURNEEN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-786-9982
Mailing Address - Street 1:100 19TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8018
Mailing Address - Country:US
Mailing Address - Phone:309-786-9982
Mailing Address - Fax:309-786-3552
Practice Address - Street 1:100 19TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8018
Practice Address - Country:US
Practice Address - Phone:309-786-9982
Practice Address - Fax:309-786-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000149251J00000X
IL3000261253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000402389Medicaid