1568506962 NPI number — JESSIFER HOME HEALTH SERVICES, INC.

Table of content: (NPI 1568506962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568506962 NPI number — JESSIFER HOME HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESSIFER HOME HEALTH 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:
1568506962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4738 N. HARLEM AVENUE STE # 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARWOOD HTS.
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-867-8310
Provider Business Mailing Address Fax Number:
708-867-8309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4738 N HARLEM AVE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARWOOD HTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60706-4638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-860-1561
Provider Business Practice Location Address Fax Number:
773-763-3217
Provider Enumeration Date:
02/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIEVES
Authorized Official First Name:
JANINA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
AGENCY SUPERVISOR
Authorized Official Telephone Number:
708-867-8310

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  65229811 , 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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