Organization
PROVENA HOME HEALTH INC
Active
Other names
Provena Home Infusioin Waukegan
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
222 S GREENLEAF AVE STE 103, GURNEE, IL 60031-5705
(847) 360-7660
(847) 360-8411
Mailing address
9223 W ST FRANCIS RD, FRANKFORT, IL 60423-8334
(815) 806-2300
(815) 806-0409
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
1010261
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04923559
BLUE SHIELD
IL
Enumeration date
05/10/2006
Last updated
08/22/2020
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