Basic Information
Provider Information
NPI: 1689018673
EntityType: 2
ReplacementNPI:  
OrganizationName: ADDUS HEALTHCARE, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ADDUS HOMECARE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2300 WARRENVILLE RD
Address2: SUITE 100
City: DOWNERS GROVE
State: IL
PostalCode: 605151765
CountryCode: US
TelephoneNumber: 6302963400
FaxNumber: 6304872713
Practice Location
Address1: 201 S 20TH ST
Address2: SUITE 11
City: ROGERS
State: AR
PostalCode: 727581104
CountryCode: US
TelephoneNumber: 4798773300
FaxNumber: 8772247103
Other Information
ProviderEnumerationDate: 04/22/2013
LastUpdateDate: 11/10/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KUMARICH
AuthorizedOfficialFirstName: DIANE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: NATIONAL CONTRACTS
AuthorizedOfficialTelephone: 6302963400
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: RN, MS, MBA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000XAR4954ARN AgenciesHome Health 
253Z00000XAR4954ARY AgenciesIn Home Supportive Care 

ID Information
IDTypeStateIssuerDescription
19734079705AR MEDICAID
19733879605AR MEDICAID
200411732 MAPC05AR MEDICAID
19734275205AR MEDICAID
19734175705AR MEDICAID


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