National Provider Identifier Database

PROVENA CARE AT HOME
Nursing Care

A Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), by employees, contracted individuals, or via a registry, in a variety of settings. The agency may engage in providing private duty nursing and/or staffing services.


Contact Information

PROVENA CARE AT HOME
1100 ESSINGTON ROAD
JOLIET, IL60435-8429
Phone: 815-773-7868
Fax:
Website:
Specialty Taxonomy Code
* Nursing Care 251J00000X

* Indicates primary specialty

NPI Profile & details for PROVENA CARE AT HOME

NPI Number 1649215831
Legal business name
LBN
PROVENA CARE AT HOME
Authorized official MICHEAL GORDON - (CHIEF FINANCIAL OFFICER)
Entity Organization
Organization subpart No
Enumeration date 06/19/2006
Last updated 05/08/2013 - About 13 years ago
Sole proprietor1 Not specified
Identifiers
  • IL License #: 1731163
  • IL Other: 09923567 BLUE SHIELD

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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