| Organization Name: | PROVENA HOME HEALTH INC |
| NPI Number: | 1043269442 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARGARET C GLEASON (PRESIDENT CEO) |
| Mailing Address: | 2018 Glenn Park Drive Champaign |
| State: | IL US |
| Postal Code: | 618219961 |
| Phone Number: | 2173554120 |
| Fax Number: | 2173554121 |
| NPI Enumeration Date: | 05/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251F00000X |
| License Number: | 1010264 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Home Infusion |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |