NPIMap

Organization Active NPI

Provena Home Health Inc

Doing business as Provena Home Infusion Urbana

  • Home Infusion Agency
  • Champaign, IL
National Provider Identifier
1043269442
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion AgencyTaxonomy code 251F00000X
License
1010264 Issued in IL
Legal business name
PROVENA HOME HEALTH INC
Doing business as
Provena Home Infusion Urbana
Practice address
2018 Glenn Park Drive
Champaign, IL 61821-9961
Phone
(217) 355-4120
Fax
(217) 355-4121
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Margaret C Gleason, RN MSN
Title
President Ceo
Phone
(815) 806-2364

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X 1010264 IL Primary

Addresses

Primary practice location

2018 Glenn Park Drive
Champaign, IL 61821-9961

Mailing address

9223 West St Francis Road
Frankfort, IL 60423-8334
Phone (815) 806-2300

Other identifiers 1

IdentifierTypeStateIssuer
01023562OtherILBLUE SHIELD

Other names 1

  • Provena Home Infusion Urbana Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Provena Home Health Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2018 Glenn Park Dr
Champaign, IL 61821
Phone (217) 355-4120

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043269442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9223 WEST ST FRANCIS ROAD",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604238334",
            "telephone_number": "815-806-2300",
            "fax_number": "815-806-0409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 GLENN PARK DRIVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618219961",
            "telephone_number": "217-355-4120",
            "fax_number": "217-355-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENA HOME HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GLEASON",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "815-806-2364",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN MSN"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "IL",
            "license": "1010264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "01023562",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provena Home Infusion Urbana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.