Provider Demographics
NPI:1376549410
Name:RESIDENTIAL CLINICAL SERVICES, INC.
Entity Type:Organization
Organization Name:RESIDENTIAL CLINICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:219-736-5718
Mailing Address - Street 1:103 W 78TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5468
Mailing Address - Country:US
Mailing Address - Phone:219-736-5718
Mailing Address - Fax:219-736-5720
Practice Address - Street 1:8102 GEORGIA ST FL 2
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6225
Practice Address - Country:US
Practice Address - Phone:219-736-5718
Practice Address - Fax:219-736-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN04-005307-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1022733OtherUNITED HEALTHCARE
IN50393OtherBCBS OF ILLINOIS
IN000000097953OtherANTHEM
IN100263870Medicaid
IN079775500OtherUS DEPT. OF LABOR