Provider Demographics
NPI:1598725103
Name:PSG SERVICES, LLC
Entity Type:Organization
Organization Name:PSG SERVICES, LLC
Other - Org Name:DBA INTERIM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BULGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-422-2934
Mailing Address - Street 1:12855 S CICERO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-3043
Mailing Address - Country:US
Mailing Address - Phone:708-422-2934
Mailing Address - Fax:708-422-5528
Practice Address - Street 1:12855 S CICERO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-3043
Practice Address - Country:US
Practice Address - Phone:708-422-2934
Practice Address - Fax:708-422-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010247251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILN306219OtherWELLCARE PROVIDER NUMBER
IL5215621OtherAETNA PROVIDER NUMBER
IL2154OtherPROF BUSINESS ADM
IL50180OtherBLUE CROSS PROVIDER NUMBE
IL000002649OtherHUMANA PROVIDER NUMBER
IL37144249001Medicaid
ILN306219OtherWELLCARE PROVIDER NUMBER