Basic Information
| Provider Information | |||||||||
| NPI: | 1902821929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRAC HOLDINGS, 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 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1388 SUTTER STREET | ||||||||
| Address2: | STE. 904 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941095438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154741468 | ||||||||
| FaxNumber: | 4154741985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DARBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP, CHIEF STRATEGY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6302963591 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADDUS HEALTHCARE INC | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 220000320 | CA | N | Agencies | Home Health | 253Z00000X | Y | Agencies | In Home Supportive Care |
ID Information
| ID | Type | State | Issuer | Description | HHA55-7580 | 05 | CA | MEDICAID | 5577580 | 01 | CA | BLUE CROSS OF CALIFORNIA | OTHER | ZZZ03607Z | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER |