Provider Demographics
NPI:1609420090
Name:VANCLEEF PERSONAL CARE HOMES LLC
Entity Type:Organization
Organization Name:VANCLEEF PERSONAL CARE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-441-1910
Mailing Address - Street 1:1060 E COUNTY LINE RD STE 3A-328
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1900
Mailing Address - Country:US
Mailing Address - Phone:773-441-1910
Mailing Address - Fax:414-386-7918
Practice Address - Street 1:1060 E COUNTY LINE RD STE 3A-328
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1900
Practice Address - Country:US
Practice Address - Phone:773-441-1910
Practice Address - Fax:414-386-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty