Provider Demographics
NPI:1679973887
Name:PF DEVELOPMENT 5, LLC
Entity type:Organization
Organization Name:PF DEVELOPMENT 5, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-814-2288
Mailing Address - Street 1:4430 MANCHESTER DR
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-8316
Mailing Address - Country:US
Mailing Address - Phone:815-397-8930
Mailing Address - Fax:815-397-8968
Practice Address - Street 1:4430 MANCHESTER DR
Practice Address - Street 2:SUITE G-1
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-8316
Practice Address - Country:US
Practice Address - Phone:815-397-8930
Practice Address - Fax:815-397-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health