Provider Demographics
NPI:1467909598
Name:SKOKIE HOME AND NURSING SERVICES
Entity Type:Organization
Organization Name:SKOKIE HOME AND NURSING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:FENELON
Authorized Official - Suffix:
Authorized Official - Credentials:MHEP
Authorized Official - Phone:84720-829-3547
Mailing Address - Street 1:4207 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4207 BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3859
Practice Address - Country:US
Practice Address - Phone:847-208-2935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000511251J00000X
IL3001334253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care