Provider Demographics
NPI:1598257693
Name:AVID HEALTH AT HOME ILLINOIS
Entity type:Organization
Organization Name:AVID HEALTH AT HOME ILLINOIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-458-6769
Mailing Address - Street 1:1375 E WOODFIELD RD STE 226
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-2428
Mailing Address - Country:US
Mailing Address - Phone:847-973-0234
Mailing Address - Fax:847-873-0227
Practice Address - Street 1:1375 E WOODFIELD RD STE 226
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-2428
Practice Address - Country:US
Practice Address - Phone:847-873-0234
Practice Address - Fax:847-873-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty