Presence Proviso Family Services Inc

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

PRESENCE PROVISO FAMILY SERVICES INC

Doing business as

Proviso Family Services Inc

Practice address

2940 N Ashland Ave
Chicago, IL 60657-4004

Phone

(773) 525-4440

Fax

(773) 525-7771

NPI assigned

Sep 12, 2011

Last updated

Apr 9, 2013By 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. Melvonne Wickliffe-Jones

Title

Credentialing MGR

Phone

(630) 914-2417

Specialties & licenses 1

Addresses

Other names 1

• Proviso Family Services Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Presence Behavioral Health

  dba ProCare Centers

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Melrose Park, IL
  • NPI 1477622298

  O20040319001574

  Same enrollment

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1235411703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BOULEVARD",
            "address_2": "SUITE 100",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604400000",
            "telephone_number": "630-914-2417",
            "fax_number": "630-914-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 N ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606574004",
            "telephone_number": "773-525-4440",
            "fax_number": "773-525-7771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE PROVISO FAMILY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2013-04-09",
        "status": "A",
        "authorized_official_last_name": "WICKLIFFE-JONES",
        "authorized_official_first_name": "MELVONNE",
        "authorized_official_title_or_position": "CREDENTIALING MGR",
        "authorized_official_telephone_number": "630-914-2417",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proviso Family Services Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Presence Healthcare Services
• Presence Healthcare Services
• Presence Healthcare Services
• Presence Healthcare Services Presence Medical Group (Resurrection Services)
• Presence Healthccare Services (Presence Medical Group)
• Presence Resurrection Medical Center
• Presence Saint Joseph Hospital (LaBoure Outpatient)
• Presence Saint Joseph Hospital (Saint Joseph Hospital)
• Presence Saint Joseph Hospital Chicago
• Presence Saints Mary and Elizabeth Medical Center

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.