1649616129 NPI number — PEKO HEALTHCARE AND CONSULTING SERVICES, INC.

Table of content: (NPI 1649616129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649616129 NPI number — PEKO HEALTHCARE AND CONSULTING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEKO HEALTHCARE AND CONSULTING 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:
PEKO HOME HEALTH SERVICES
Provider Other Organization Name Type Code:
3
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:
1649616129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4986 GIBSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTESON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60443-3023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-912-7672
Provider Business Mailing Address Fax Number:
708-747-1343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
526 E 87TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60619-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-912-7672
Provider Business Practice Location Address Fax Number:
708-747-1343
Provider Enumeration Date:
05/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
OWUSU
Authorized Official First Name:
SETH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT/AGENCY ADMINISTRATOR
Authorized Official Telephone Number:
708-539-9014

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1011433 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251F00000X , with the licence number: 4000342 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 3000756 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1011433 . This is a "ILLINOIS DEPARTMENT OF PUBLIC HEALTH: HOME HEALTH AGENCY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4000342 . This is a "ILLINOIS DEPARTMENT OF PUBLIC HEALTH: HOME NURSING AGENCY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3000756 . This is a "ILLINOIS DEPARTMENT OF PUBLIC HEALTH: HOME SERVICES AGENCY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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