Provider Demographics
NPI:1376061259
Name:STATEWIDE HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:STATEWIDE HEALTHCARE SERVICES, INC
Other - Org Name:OXFORD HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, OPERATIONOS
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:822-404-3191
Mailing Address - Street 1:1 N STATE ST STE 800
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3312
Mailing Address - Country:US
Mailing Address - Phone:800-404-3191
Mailing Address - Fax:312-704-1126
Practice Address - Street 1:1060 BAILEY DR
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3114
Practice Address - Country:US
Practice Address - Phone:334-289-2531
Practice Address - Fax:334-289-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health