Basic Information
| Provider Information | |||||||||
| NPI: | 1093731655 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PRAC HOLDINGS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WARRENVILLE RD., STE 100 | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302963530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1090 E CYPRESS AVE STE B | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960021163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302232332 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 04/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | KUMARICH | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP NATIONAL CONTRACTS | ||||||||
| AuthorizedOfficialTelephone: | 6302963400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADDUS HEALTHCARE INC | ||||||||
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| AuthorizedOfficialCredential: | RN, MS, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.