Provider Demographics
NPI:1588136600
Name:ABC ADULT CARE LLC
Entity type:Organization
Organization Name:ABC ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIJI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNY
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:224-600-8778
Mailing Address - Street 1:7 N EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6615
Mailing Address - Country:US
Mailing Address - Phone:224-600-8778
Mailing Address - Fax:
Practice Address - Street 1:7 N EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6615
Practice Address - Country:US
Practice Address - Phone:224-600-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty