Provider Demographics
NPI:1144413048
Name:MEDSERVE HOME HEALTHCARE, INC
Entity Type:Organization
Organization Name:MEDSERVE HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / DON
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:GASPAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-282-6721
Mailing Address - Street 1:4001 W DEVON AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4539
Mailing Address - Country:US
Mailing Address - Phone:773-282-6721
Mailing Address - Fax:866-337-8961
Practice Address - Street 1:4001 W DEVON AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4539
Practice Address - Country:US
Practice Address - Phone:773-282-6721
Practice Address - Fax:866-337-8961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010753251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health