Provider Demographics
NPI:1922733302
Name:PANOPTIC HOME CARE LLC
Entity Type:Organization
Organization Name:PANOPTIC HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:815-513-3298
Mailing Address - Street 1:1802 N DIVISION ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3104
Mailing Address - Country:US
Mailing Address - Phone:815-513-3298
Mailing Address - Fax:815-513-5446
Practice Address - Street 1:1802 N DIVISION ST STE 202
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3104
Practice Address - Country:US
Practice Address - Phone:815-513-3298
Practice Address - Fax:815-513-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care