Provider Demographics
NPI:1255512364
Name:ADDUS HEALTHCARE, INC
Entity type:Organization
Organization Name:ADDUS HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP, CHIEF STRATEGY OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-3591
Mailing Address - Street 1:2300 WARRENVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1717
Mailing Address - Country:US
Mailing Address - Phone:630-296-3400
Mailing Address - Fax:630-487-2713
Practice Address - Street 1:1506 ROUTE 61 HWY S
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-8409
Practice Address - Country:US
Practice Address - Phone:570-622-9882
Practice Address - Fax:855-223-6216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDUS HOMECARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100728460-0005Medicaid
PA1007284600010Medicaid