Organization
PROVENA HOME HEALTH INC
Active
Other names
Provena Home Infusion Urbana
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARGARET C GLEASON RN MSN (PRESIDENT CEO)
(815) 806-2364
Entity
Organization
Contact information
Practice address
2018 GLENN PARK DRIVE, CHAMPAIGN, IL 61821-9961
(217) 355-4120
(217) 355-4121
Mailing address
9223 WEST ST FRANCIS ROAD, FRANKFORT, IL 60423-8334
(815) 806-2300
(815) 806-0409
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
1010264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01023562
BLUE SHIELD
IL
Enumeration date
05/10/2006
Last updated
08/22/2020
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