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Organization

PROVENA CARE AT HOME

Active
Other names
Provena Home Medical Equipment
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
1100 ESSINGTON ROAD, JOLIET, IL 60435-8429
(815) 773-7868
Mailing address
9223 WEST ST FRANCIS ROAD, FRANKFORT, IL 60423
(815) 806-2300
(815) 806-0409

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
11580037
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
9923629
BLUESHIELD
IL
Enumeration date
06/19/2006
Last updated
08/22/2020
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