Provider Demographics
NPI:1114381662
Name:FSJN ENTERPRISES, INC
Entity Type:Organization
Organization Name:FSJN ENTERPRISES, INC
Other - Org Name:SYNERGY HOMECARE OF NORTHEAST CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-868-3183
Mailing Address - Street 1:1802 W BERTEAU AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6182
Mailing Address - Country:US
Mailing Address - Phone:773-868-3183
Mailing Address - Fax:
Practice Address - Street 1:1802 W BERTEAU AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6182
Practice Address - Country:US
Practice Address - Phone:630-802-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001394253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care