Provena Care at Home

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

License

1731163 Issued in IL

Legal business name

PROVENA CARE AT HOME

Practice address

1100 Essington Road
Joliet, IL 60435-8429

Phone

(815) 773-7868

NPI assigned

Jun 19, 2006

Last updated

May 8, 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

Micheal Gordon

Title

Chief Financial Officer

Phone

(708) 478-7911

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367971200000",
    "number": "1649215831",
    "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": "60423",
            "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": "1100 ESSINGTON ROAD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604358429",
            "telephone_number": "815-773-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENA CARE AT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2013-05-08",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "MICHEAL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "708-478-7911"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "IL",
            "license": "1731163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "09923567",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Pritz, PHARMD, RPH
• Promises of Recovery
• Propensity ABA Services, LLC
• Anthony E Proske, MD
• Provena Care at Home (Provena Home Medical Equipment)
• Provena Home Health Inc (Provena Home Infusion Joliet)
• Gianna Marie Prucha, PA
• Bianca Pruitt, RN,MSN,DNP,CCM
• Essie Pearllena Pruitt, LCSW
• Lisa Przybysz

• Nursing Care Agency in Joliet, IL
• Providers in Joliet, IL by specialty
• Nursing Care Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; 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.