BROOKE BALL (NPI# 1366063539) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1366063539 |
Entity Type | Individual |
Full Name | BROOKE BALL |
Credential | CNA |
Practice Address |
203 Constitution Dr Sw # B Poplar Grove IL 61065-8729 |
Practice Telephone | 8153555369 |
Enumeration Date | 2020-04-29 |
Last Update Date | 2020-04-29 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 251J00000X | Nursing Care | Agencies | ||
Y | 3747A0650X |
Technician Specialization: Attendant Care Provider |
Nursing Service Related Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NONE | NONE | 01 |
Address | Telephone Number | Fax Number |
---|---|---|
4919 Rolex Pkwy, Loves Park, IL 611116223 | 8153555369 |
Street Address |
203 CONSTITUTION DR SW # B |
City | POPLAR GROVE |
State | IL |
Zip Code | 61065-8729 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992352819 | Amber Suarez-christensen | Occupational Therapist | 4950 Il-173, Poplar Grove, IL 61065 | 2019-08-26 |
1588227300 | Kimberly Jozwiak | Counselor | 4950 Rte. 173, Poplar Grove, IL 61065 | 2019-04-17 |
1902252075 | Pioneer Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 310 Constitution Drive Sowth West, Poplar Grove, IL 61065 | 2016-05-09 |
1568738821 | Ashley Lynn Moritz | Speech-Language Pathologist | 4950 Route 173, Poplar Grove, IL 61065 | 2012-03-30 |
1326202441 | Felker Pharmacy Inc | Pharmacy | 13521 Illinois Rt 76, Poplar Grove, IL 61065 | 2008-07-17 |
1295744183 | William M Bitsas | Family Medicine | 406 Maple Leaf Ln, Poplar Grove, IL 61065 | 2006-08-07 |
1790718104 | Troy Michael Doetch | Family Medicine | 1200 Candlewick Dr Nw, Poplar Grove, IL 61065 | 2006-07-09 |
1548667371 | Gemma Fletcher | Physical Therapist | 4950 Route 173, Poplar Grove, IL 61065 | 2014-11-21 |
1700207768 | Kathy Blackmer | Counselor | 13508 Julie Dr, Poplar Grove, IL 61065 | 2013-12-18 |
1598883670 | Jeffry Stephen Clow | Speech-Language Pathologist | 492 Prairie Knoll Dr, Poplar Grove, IL 61065-7817 | 2007-03-27 |
Find all providers in zip 61065 |
Taxonomy Code | 3747A0650X |
Grouping | Nursing Service Related Providers |
Classification | Technician |
Specialization | Attendant Care Provider |
An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396392189 | Mark Currier | Technician | 103 Bradford Pl Se, Poplar Grove, IL 61065-8780 | 2019-08-26 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881294874 | Paulette Lovelace | Technician | 521 Vicksburg Dr, Belleville, IL 62221-6670 | 2020-10-28 |
1891395893 | Cheryl Lynn Eubanks | Technician | 1710 Mccasland Ave, East Saint Louis, IL 62207-2245 | 2020-10-28 |
1043818446 | Sabrina Marie Williams | Technician | 211 S Lodge St, Shelbyville, IL 62565-1951 | 2020-10-16 |
1124626213 | Tonya Lee Burdell | Technician | 315 S Douglas St, Litchfield, IL 62056-1851 | 2020-10-12 |
1720685704 | Itzayana Rodriguez | Technician | 5037 Carol Ct, Rockford, IL 61108-4157 | 2020-10-02 |
1871108209 | Ashley Marie Dawkins | Technician | 528 Grant Dr, Quincy, IL 62301-7234 | 2020-09-11 |
1104437797 | Stephen T Medford | Technician | 1017 Hartman Ln, O Fallon, IL 62269-7207 | 2020-08-16 |
1528685088 | Maxine Washington | Technician | 2014 S. 17th Ave., Broadview, IL 60155-2906 | 2020-07-01 |
1316562788 | Salli Jacobsen | Technician | 6699 Torch Lite Tr, Loves Park, IL 61111 | 2020-06-11 |
1356962377 | Brenda Lou Isermann | Technician | 406 W South 2nd St, Shelbyville, IL 62565-2114 | 2020-04-30 |
Find all providers with the same taxonomy |
City | POPLAR GROVE |
Zip Code | 61065 |
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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.