Provider Demographics
NPI:1164282794
Name:JONES, SHERITA DIANE (CEO)
Entity Type:Individual
Prefix:
First Name:SHERITA
Middle Name:DIANE
Last Name:JONES
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 163RD PL
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-6001
Mailing Address - Country:US
Mailing Address - Phone:708-969-6805
Mailing Address - Fax:
Practice Address - Street 1:33 163RD PL
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-6001
Practice Address - Country:US
Practice Address - Phone:708-969-6805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty