Provider Demographics
NPI:1588182455
Name:STATEWIDE HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:STATEWIDE HEALTHCARE SERVICES, INC
Other - Org Name:OXFORD HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-795-4683
Mailing Address - Street 1:1 N STATE ST STE 800
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3312
Mailing Address - Country:US
Mailing Address - Phone:800-404-3191
Mailing Address - Fax:
Practice Address - Street 1:80 ALI WAY
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1835
Practice Address - Country:US
Practice Address - Phone:256-831-7146
Practice Address - Fax:256-831-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health