Provider Demographics
NPI:1891747986
Name:AESQUIVEL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:AESQUIVEL PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMDON
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARICLAIRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-922-8100
Mailing Address - Street 1:9721 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3616
Mailing Address - Country:US
Mailing Address - Phone:219-922-8100
Mailing Address - Fax:219-922-1700
Practice Address - Street 1:9721 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3616
Practice Address - Country:US
Practice Address - Phone:219-922-8100
Practice Address - Fax:219-922-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15-7558251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-7558Medicare ID - Type UnspecifiedPROVIDER NUMBER