Provider Demographics
NPI:1063653020
Name:SOUTH SUBURBAN HEALTHCARE, INC
Entity Type:Organization
Organization Name:SOUTH SUBURBAN HEALTHCARE, INC
Other - Org Name:BRIGHTSTAR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HISEY PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-532-2273
Mailing Address - Street 1:17055 S. HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477
Mailing Address - Country:US
Mailing Address - Phone:708-532-2273
Mailing Address - Fax:708-633-6100
Practice Address - Street 1:17055 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2739
Practice Address - Country:US
Practice Address - Phone:708-532-2273
Practice Address - Fax:708-633-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion