Presence Heritage Day Break

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

PRESENCE HERITAGE DAY BREAK

Practice address

1025 N Washington Ave
Kankakee, IL 60901-2059

Phone

(815) 937-2447

Fax

(708) 478-5387

NPI assigned

Mar 23, 2015

Organization subpart

Yes

Parent organization

PRESENCE LIFE CONNECTIONSAs reported in NPPES

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

Authorized official

Name

Mr. Michael Gordon

Title

Cfo

Phone

(708) 478-7911

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Presence Heritage Day Break

Locations

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

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427068800000",
    "number": "1962896431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 N WASHINGTON AVE",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012059",
            "telephone_number": "815-937-2447",
            "fax_number": "708-478-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 N WASHINGTON AVE",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012059",
            "telephone_number": "815-937-2447",
            "fax_number": "708-478-5387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE HERITAGE DAY BREAK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESENCE LIFE CONNECTIONS",
        "enumeration_date": "2015-03-23",
        "last_updated": "2015-03-23",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "708-478-7911",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS DEPARTMENT OF AGING",
            "identifier": "ADS1002010",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pinnacle Opportunities Inc
• Annise Pitts
• Premier Anesthesia of Illinois Professional Corporation
• Presence Central and Suburban Hospitals Network
• Presence Central and Suburban Hospitals Network
• Presence Home Care
• Presence Life Connections
• Presence St. Mary Hospital
• Prime Healthcare Associates, Inc.
• Prime Healthcare Home Care and Hospice, LLC

• Adult Day Care Clinic/Center in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Adult Day Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.