Provider Demographics
NPI:1093771917
Name:ESSEX HOME HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:ESSEX HOME HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-933-0494
Mailing Address - Street 1:8018 S ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1221
Mailing Address - Country:US
Mailing Address - Phone:773-933-0494
Mailing Address - Fax:773-933-0528
Practice Address - Street 1:8018 S ESSEX AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1221
Practice Address - Country:US
Practice Address - Phone:773-933-0494
Practice Address - Fax:773-933-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011724251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147705Medicaid
IL5435OtherHOME HEALTH CARE
IL147705Medicaid