Provider Demographics
NPI:1568506962
Name:JESSIFER HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:JESSIFER HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MBA
Authorized Official - Phone:708-867-8310
Mailing Address - Street 1:4738 N. HARLEM AVENUE STE # 3
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HTS.
Mailing Address - State:IL
Mailing Address - Zip Code:60706
Mailing Address - Country:US
Mailing Address - Phone:708-867-8310
Mailing Address - Fax:708-867-8309
Practice Address - Street 1:4738 N HARLEM AVE STE 3
Practice Address - Street 2:
Practice Address - City:HARWOOD HTS
Practice Address - State:IL
Practice Address - Zip Code:60706-4638
Practice Address - Country:US
Practice Address - Phone:773-860-1561
Practice Address - Fax:773-763-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL65229811251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148100Medicare PIN