Provider Demographics
NPI:1669003083
Name:ILLINOIS SENIOR SERVICES INC
Entity Type:Organization
Organization Name:ILLINOIS SENIOR SERVICES INC
Other - Org Name:ILLINOIS SENIOR SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAJEED
Authorized Official - Middle Name:ABDUL
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-336-7632
Mailing Address - Street 1:2634 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1887
Mailing Address - Country:US
Mailing Address - Phone:773-336-7632
Mailing Address - Fax:773-249-1244
Practice Address - Street 1:2634 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1887
Practice Address - Country:US
Practice Address - Phone:773-336-7632
Practice Address - Fax:773-249-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty