Provider Demographics
NPI:1598739377
Name:SSM HOME CARE AT ST. FRANCIS BLUE ISLAND
Entity Type:Organization
Organization Name:SSM HOME CARE AT ST. FRANCIS BLUE ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2528
Mailing Address - Street 1:13000 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2318
Mailing Address - Country:US
Mailing Address - Phone:708-371-7777
Mailing Address - Fax:
Practice Address - Street 1:13000 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2318
Practice Address - Country:US
Practice Address - Phone:708-371-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH BUSINESSES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-16
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101C183251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14-7405BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER