Provider Demographics
NPI:1245833920
Name:AVIENSE HOME HEALTHCARE, INC
Entity type:Organization
Organization Name:AVIENSE HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-230-5100
Mailing Address - Street 1:5105 TOLLVIEW DR STE 180
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3724
Mailing Address - Country:US
Mailing Address - Phone:815-230-5100
Mailing Address - Fax:815-846-0841
Practice Address - Street 1:5105 TOLLVIEW DR STE 180
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3724
Practice Address - Country:US
Practice Address - Phone:815-230-5100
Practice Address - Fax:815-846-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1012044OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH