Provider Demographics
NPI:1124577382
Name:AXIS HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:AXIS HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-405-6321
Mailing Address - Street 1:6645 N OLIPHANT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1390
Mailing Address - Country:US
Mailing Address - Phone:312-405-6321
Mailing Address - Fax:
Practice Address - Street 1:6645 N OLIPHANT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1390
Practice Address - Country:US
Practice Address - Phone:312-405-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000453253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care