Provider Demographics
NPI:1720371008
Name:GRANNY'S BLESSINGS HOMECARE SERVICES, INC.
Entity Type:Organization
Organization Name:GRANNY'S BLESSINGS HOMECARE SERVICES, INC.
Other - Org Name:GRANNY'S BLESSINGS STAFFING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONSURAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NWOKENKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-401-8769
Mailing Address - Street 1:12416 S HARLEM AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1441
Mailing Address - Country:US
Mailing Address - Phone:708-827-5434
Mailing Address - Fax:
Practice Address - Street 1:12416 S HARLEM AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1441
Practice Address - Country:US
Practice Address - Phone:708-827-5434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000276251J00000X
IL3000522253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care