Provider Demographics
NPI:1407093347
Name:SURE CARE HOME SERVICES, INC.
Entity Type:Organization
Organization Name:SURE CARE HOME SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASICLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-295-9058
Mailing Address - Street 1:1155 N MAIN ST
Mailing Address - Street 2:SUITE C & D
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3508
Mailing Address - Country:US
Mailing Address - Phone:630-295-9058
Mailing Address - Fax:630-295-9059
Practice Address - Street 1:1155 N MAIN ST
Practice Address - Street 2:SUITE C & D
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3508
Practice Address - Country:US
Practice Address - Phone:630-295-9058
Practice Address - Fax:630-295-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL66258807253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL66258807OtherSTATE OF ILLNOIS BUSINESS LICENSE
ILPENDING/PROVISIONALOtherILLINOIS DEPARTMENT OF PUBLIC HEALTH LICENSE