PMR ILLINOIS HOLDING, LLC (NPI# 1013520113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013520113 |
| Entity Type | Organization |
| Organization Name | PMR ILLINOIS HOLDING, LLC |
| Practice Address |
600 E Sibley Blvd Dolton IL 60419-2599 |
| Mailing Address |
1395 Nw 167th St Miami Gardens FL 33169-5710 |
| Practice Telephone | 7083407400 |
| Mailing Telephone | 3056286117 |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |
| Authorized Official Name | MARY CHEN (EXECUTIVE) |
| Authorized Official Telephone | 3056286117 |
| Is Organization Subpart | Y |
| Parent Organization Name | PMR ILLINOIS HOLDING, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| Other Name | Type Code |
|---|---|
| JenCare Senior Medical Center Dolton | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770038671 | Pmr Illinois Holding, LLC | Non-Pharmacy Dispensing Site | 1395 Nw 167th St, Miami Gardens, FL 33169-5742 | 2016-08-20 |
| Street Address |
600 E SIBLEY BLVD |
| City | DOLTON |
| State | IL |
| Zip Code | 60419-2599 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063985174 | Adesola O Bello | Occupational Therapist | 15325 Dante Ave, Dolton, IL 60419 | 2019-01-10 |
| 1780159657 | Angela Denice Carter | Social Worker | 15400 University, Dolton, IL 60419 | 2018-10-08 |
| 1417322165 | Gregory Peck Stapleton Sr. | Non-emergency Medical Transport (VAN) | 15320 South Evers, Dolton, IL 60419 | 2015-12-07 |
| 1780055624 | Royal Estates Assistive Living LLC | Assisted Living Facility | 1515 E 154th St., Dolton, IL 60419 | 2015-10-19 |
| 1013217264 | Bestmed-care Services,ltd | Home Health | 15008 S Woodlawn Avenue, Dolton, IL 60419 | 2010-10-21 |
| 1689905168 | Faith Connections Home Health and Professional Service Corporation | Home Health | 15335 Sunset Dr, Dolton, IL 60419 | 2010-01-22 |
| 1053555235 | Aunt Martha's Youth Service Center, Inc | Community Based Residential Treatment Facility, Mental Illness | 14449 Vanburen, Dolton, IL 60419 | 2009-05-01 |
| 1912163437 | Quality Dental, Inc | Dentist | 1121 E. Sibley Blvd, Dolton, IL 60419 | 2008-08-04 |
| 1013138171 | Valerie Denise Hicks-beal | Developmental Therapist | 14501 S. Dobson, Dolton, IL 60419 | 2007-05-02 |
| 1417178096 | Rhonda D Williams | Occupational Therapy Assistant | 15205 Diekman Court, Dolton, IL 60419 | 2007-05-01 |
| Find all providers in zip 60419 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386255123 | Dermatology Associates Ltd | Non-Pharmacy Dispensing Site | 13401 S Ridgeland Ave, Palos Heights, IL 60463-1898 | 2020-08-14 |
| 1497398648 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 853 W Jackson Plaza, Morton, IL 61550 | 2019-10-21 |
| 1902449382 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 1730 Bradford Ln, Normal, IL 61761-1297 | 2019-10-18 |
| 1073173134 | Shobhana Patodia | Non-Pharmacy Dispensing Site | 1111 Superior St Ste 206, Melrose Park, IL 60160-4156 | 2019-06-19 |
| 1215494620 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 3653 N Vermilion Dr, Danville, IL 61832 | 2019-02-22 |
| 1306303714 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 520 N Cunningham Avenue, 5 Points Shopping Center, Urbana, IL 61802 | 2019-02-22 |
| 1124585534 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 5209 W. War Memorial Drive, Grand Prairie Mall, Peoria, IL 61615-9250 | 2019-02-22 |
| 1871050237 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 508 Iaa Dr, Bloomington, IL 61701-2216 | 2019-02-21 |
| 1518424969 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 2901 Columbus St, Ottawa, IL 61350-1009 | 2019-02-21 |
| 1386118057 | Derick Dermatology, LLC | Non-Pharmacy Dispensing Site | 263 Shuman Boulevard, Suite 125, Naperville, IL 60563 | 2019-01-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.