Provider Demographics
NPI:1508173535
Name:AC PERFORMANCE PRO SYS HEWITT HOME CARE-AC PERF PRO
Entity Type:Organization
Organization Name:AC PERFORMANCE PRO SYS HEWITT HOME CARE-AC PERF PRO
Other - Org Name:HEWPRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:773-675-6381
Mailing Address - Street 1:5135 S BLACKSTONE APT 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615
Mailing Address - Country:US
Mailing Address - Phone:773-675-6381
Mailing Address - Fax:
Practice Address - Street 1:5135 S BLACKSTONE AVE APT 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-6309
Practice Address - Country:US
Practice Address - Phone:773-675-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL330483055253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care