Basic Information
| Provider Information | |||||||||
| NPI: | 1386016244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADDUS HEALTHCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WARRENVILLE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302963400 | ||||||||
| FaxNumber: | 6304872713 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 CHATHAM SQ PARK STE A | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224052561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034972273 | ||||||||
| FaxNumber: | 7039107365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2015 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DARBY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EVP, CHIEF STRATEGY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6302963591 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADDUS HOMECARE CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Community Health Worker | 347C00000X | N | Transportation Services | Private Vehicle | 372500000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Chore Provider | 372600000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Adult Companion | 3747A0650X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Technician | Attendant Care Provider | 3747P1801X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Technician | Personal Care Attendant | 374U00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Home Health Aide | 376J00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Homemaker | 376K00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Nurse's Aide | 253Z00000X | Y | Agencies | In Home Supportive Care |
No ID Information.