Provider Demographics
NPI:1902862568
Name:ADDUS HEALTHCARE INC
Entity Type:Organization
Organization Name:ADDUS HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR NATIONAL CONTRACTS
Authorized Official - Prefix:MR
Authorized Official - First Name:DARBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-3591
Mailing Address - Street 1:2300 WARRENVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1717
Mailing Address - Country:US
Mailing Address - Phone:630-296-3400
Mailing Address - Fax:630-487-2713
Practice Address - Street 1:1101 W SARGENT ST, STE A
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-3008
Practice Address - Country:US
Practice Address - Phone:217-854-4471
Practice Address - Fax:855-808-6977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDUS HOMECARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-24
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251F00000X, 251J00000X, 253Z00000X
IL1699632251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147716Medicare Oscar/Certification