Provider Demographics
NPI:1003482753
Name:INTERSERVE HOME NURSING SERVICES LLC
Entity Type:Organization
Organization Name:INTERSERVE HOME NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKANLAWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-290-0245
Mailing Address - Street 1:11723 GLENN CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5794
Mailing Address - Country:US
Mailing Address - Phone:773-290-0245
Mailing Address - Fax:630-296-6149
Practice Address - Street 1:11723 GLENN CIR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5794
Practice Address - Country:US
Practice Address - Phone:773-290-0245
Practice Address - Fax:630-296-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care