Provider Demographics
NPI:1790776888
Name:GREATLAND HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GREATLAND HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MONSURU
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-548-2126
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-0141
Mailing Address - Country:US
Mailing Address - Phone:630-548-2126
Mailing Address - Fax:630-364-1506
Practice Address - Street 1:24W500 MAPLE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6055
Practice Address - Country:US
Practice Address - Phone:630-548-2126
Practice Address - Fax:630-364-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-29
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1010350251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50432OtherBLUE CROSS BLUE SHIELD
IL7717763OtherAETNA
ILIL1010350OtherSTATE LICENSE
IL50432OtherBLUE CROSS BLUE SHIELD
IL=========-001Medicaid
IL=========-001Medicaid