1649813643 NPI number — FAMILY CARE SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649813643 NPI number — FAMILY CARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CARE 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:
1649813643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17680 SOUTH KEDZIE AVE
Provider Second Line Business Mailing Address:
SUITE 106B
Provider Business Mailing Address City Name:
HAZEL CREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60429-2043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-206-2200
Provider Business Mailing Address Fax Number:
708-991-7247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5320 159TH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK FOREST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60452-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-206-2200
Provider Business Practice Location Address Fax Number:
708-991-7247
Provider Enumeration Date:
10/22/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAWAT
Authorized Official First Name:
MANOLO
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENCY MANAGER
Authorized Official Telephone Number:
708-206-2200

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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