1093025694 NPI number — CLASSIC HOMECARE SERVICES INC

Table of content: (NPI 1093025694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093025694 NPI number — CLASSIC HOMECARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLASSIC HOMECARE SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093025694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/09/2020
NPI Reactivation Date:
11/18/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 FAIRFIELD WAY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60108-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-240-3719
Provider Business Mailing Address Fax Number:
224-432-6072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 FAIRFIELD WAY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60108-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-240-3719
Provider Business Practice Location Address Fax Number:
224-432-6072
Provider Enumeration Date:
10/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ATKINS
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-240-3719

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)