Provider Demographics
NPI:1114200979
Name:MICKEYS SENIOR CARE GROUP INC
Entity Type:Organization
Organization Name:MICKEYS SENIOR CARE GROUP INC
Other - Org Name:COMFORCARE HOME CARE - NW COOK COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-823-0800
Mailing Address - Street 1:111 S. WASHINGTON, STE 104
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-823-0800
Mailing Address - Fax:847-692-6033
Practice Address - Street 1:111 S. WASHINGTON
Practice Address - Street 2:SUITE 104
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-823-0800
Practice Address - Fax:847-692-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000793253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care