Provider Demographics
NPI:1619151891
Name:SENIOR AND CHILD HOMECARE SVC
Entity Type:Organization
Organization Name:SENIOR AND CHILD HOMECARE SVC
Other - Org Name:SENIOR STAFFING CARE PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-351-2064
Mailing Address - Street 1:#10 HESIN PLACE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-6830
Mailing Address - Country:US
Mailing Address - Phone:217-621-8251
Mailing Address - Fax:217-355-3444
Practice Address - Street 1:10 HENSON PL
Practice Address - Street 2:SUITE 4
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7836
Practice Address - Country:US
Practice Address - Phone:217-621-8251
Practice Address - Fax:217-355-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health