Provider Demographics
NPI:1043975204
Name:BICKFORD HOME CARE OF WESTERN SUBURBS, LLC
Entity Type:Organization
Organization Name:BICKFORD HOME CARE OF WESTERN SUBURBS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP OF OPS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-782-3200
Mailing Address - Street 1:13795 S MUR LEN RD STE 301
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1096
Mailing Address - Country:US
Mailing Address - Phone:614-846-6500
Mailing Address - Fax:
Practice Address - Street 1:40W304 LAFOX RD UNIT B
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6581
Practice Address - Country:US
Practice Address - Phone:913-782-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health