Organization
PRESENCE HOME CARE
Active
Parent organization
PROVENA HEALTH
Other names
Presence Home Care - Urbana
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVENA HEALTH
Authorized official
MICHAEL GORDON (CFO)
(708) 478-7911
Entity
Organization
Contact information
Practice address
1501 INTERSTATE DR, CHAMPAIGN, IL 61822-1006
(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
251E00000X
Home Health Agency
Primary
1010264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4604853581004
—
IL
01
—
50162
BC BS
IL
Enumeration date
05/08/2006
Last updated
04/12/2013
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