| Organization Name: | PROVENA CARE AT HOME |
| NPI Number: | 1386689610 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARGARET C GLEASON (PRESIDENT CEO) |
| Mailing Address: | 1100 Essington Road Joliet |
| State: | IL US |
| Postal Code: | 604358429 |
| Phone Number: | 8157737868 |
| Fax Number: | |
| NPI Enumeration Date: | 06/19/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 11580037 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |