Provider Demographics
NPI:1639456551
Name:A 1 SALEM HEALTHCARE C ONSULTANT INC.
Entity Type:Organization
Organization Name:A 1 SALEM HEALTHCARE C ONSULTANT INC.
Other - Org Name:A-1 SALEM HOME HEALTHCARE/HOMEMAKER & CONSULTANT INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKENKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-257-6018
Mailing Address - Street 1:187 S SCHUYLER AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3831
Mailing Address - Country:US
Mailing Address - Phone:708-401-3334
Mailing Address - Fax:708-401-4095
Practice Address - Street 1:187 S SCHUYLER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3831
Practice Address - Country:US
Practice Address - Phone:708-401-3334
Practice Address - Fax:708-401-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011459251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011459OtherIDPH LICENSE #