Provider Demographics
NPI:1134178338
Name:PRESENCE HOME CARE
Entity type:Organization
Organization Name:PRESENCE HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKNISKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-213-0776
Mailing Address - Street 1:555 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3664
Mailing Address - Country:US
Mailing Address - Phone:815-937-2475
Mailing Address - Fax:815-936-5155
Practice Address - Street 1:555 W COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3664
Practice Address - Country:US
Practice Address - Phone:815-937-2475
Practice Address - Fax:815-936-5155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESENCE CARE TRANSFORMATION CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-08
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010262251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50161OtherBCBS
IL50161OtherBCBS