Organization
PROVENA HOME HEALTH INC
Active
Parent organization
PROVENA HEALTH
Other names
Provena Home Health Inc Waukegan
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVENA HEALTH
Authorized official
MRS. MARGARET C GLEASON RN MSN (PRESIDENT CEO)
(815) 806-2364
Entity
Organization
Contact information
Practice address
222 SOUTH GREENLEAF AVE, SUITE 103, GURNEE, IL 60031-5705
(847) 360-7660
(847) 360-8411
Mailing address
9223 WEST ST FRANCIS ROAD, FRANKFORT, IL 60423-8334
(815) 806-2300
(815) 806-0409
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010261
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50163
BC BS
IL
Enumeration date
05/08/2006
Last updated
09/16/2009
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