Provider Demographics
NPI:1265672307
Name:SIGNATURE HOMECARE SERVICES, INC.,
Entity Type:Organization
Organization Name:SIGNATURE HOMECARE SERVICES, INC.,
Other - Org Name:AT HOME QUALITY CARE-MORRIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-942-1256
Mailing Address - Street 1:7820 GRAPHIC DR STE 201
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6278
Mailing Address - Country:US
Mailing Address - Phone:773-685-9025
Mailing Address - Fax:773-685-9066
Practice Address - Street 1:519 FRANKLIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1880
Practice Address - Country:US
Practice Address - Phone:815-942-1256
Practice Address - Fax:815-942-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011106251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-7263Medicare PIN