Provider Demographics
NPI:1881645125
Name:PRESENCE HOME CARE
Entity Type:Organization
Organization Name:PRESENCE HOME CARE
Other - Org Name:PRESENCE HOME CARE - JOLIET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-478-7911
Mailing Address - Street 1:9223 W ST FRANCIS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8334
Mailing Address - Country:US
Mailing Address - Phone:815-806-2300
Mailing Address - Fax:815-806-0409
Practice Address - Street 1:1060 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2841
Practice Address - Country:US
Practice Address - Phone:815-741-7371
Practice Address - Fax:815-773-7450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVENA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010263251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50160OtherBCBS
IL50160OtherBCBS
IL=========003Medicaid