Provider Demographics
NPI:1033462288
Name:SOUTHWEST COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHWEST COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAT
Authorized Official - Last Name:AMBROSINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-429-1260
Mailing Address - Street 1:6775 PROSPERI DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4789
Mailing Address - Country:US
Mailing Address - Phone:708-429-1260
Mailing Address - Fax:708-429-9107
Practice Address - Street 1:58 W 162ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2061
Practice Address - Country:US
Practice Address - Phone:708-825-1986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04128343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)