Providence Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0028605 Issued in IL

Legal business name

PROVIDENCE OPERATIONS, LLC

Doing business as

Providence Downers Grove

Practice address

3450 Saratoga Ave
Downers Grove, IL 60515-1141

Phone

(630) 969-2900

Fax

(630) 969-2900

NPI assigned

Jun 1, 2005

Last updated

Aug 13, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Johanna R Zandstra

Title

Compliance Officer

Phone

(708) 342-8137

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Providence Downers Grove Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Rest Haven Illiana Christian Convalescent Home

  dba Providence Hospice

  • Community Based Hospice Care Agency
  • Homer Glen, IL
  • NPI 1407855562

  Member Of

  NPD member

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439424000000",
    "number": "1184626434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18601 NORTH CREEK DRIVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "60477",
            "telephone_number": "708-342-8100",
            "fax_number": "708-342-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 SARATOGA AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151141",
            "telephone_number": "630-969-2900",
            "fax_number": "630-969-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2015-08-13",
        "status": "A",
        "authorized_official_last_name": "ZANDSTRA",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "708-342-8137",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0028605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362382853003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Downers Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Price, RBT
• Samantha Proctor, LCPC
• Janey Prodoehl
• Donald Joseph Provenzale Jr., DDS
• Megan Provenzale
• PSC Cardiorad LLC
• PSC Diagnostics LLC
• Psychiatry Oasis LLC
• Janet Puderbaugh, MS OTR L
• Skye C Puls, OD

• Skilled Nursing Facility in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; 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.