Provider Demographics
NPI:1639594559
Name:SSANJJEMMA CARE PROVIDER INC.
Entity Type:Organization
Organization Name:SSANJJEMMA CARE PROVIDER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-495-9668
Mailing Address - Street 1:3622 SALEM WALK APT A2
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7331
Mailing Address - Country:US
Mailing Address - Phone:773-495-9668
Mailing Address - Fax:
Practice Address - Street 1:3622 SALEM WALK APT A2
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7331
Practice Address - Country:US
Practice Address - Phone:773-495-9668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health