1558508051 NPI number — SIGNATURE HOMECARE SERVICES INC

Table of content: (NPI 1558508051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558508051 NPI number — SIGNATURE HOMECARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGNATURE 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:
6
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:
1558508051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7820 GRAPHIC DR STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINLEY PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60477-6278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-685-9025
Provider Business Mailing Address Fax Number:
773-685-9066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 FRANKLIN ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60450-1881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-942-1256
Provider Business Practice Location Address Fax Number:
815-942-5203
Provider Enumeration Date:
01/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BOXWALLA
Authorized Official First Name:
ABITURAB 'ABI'
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
708-825-4060

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  APPLIED FOR , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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