Provider Demographics
NPI:1912035429
Name:SUNSET NEIGHBORHOOD SERVICES, CORP.
Entity Type:Organization
Organization Name:SUNSET NEIGHBORHOOD SERVICES, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:DR
Authorized Official - First Name:GABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PYKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-614-8784
Mailing Address - Street 1:9303 SOUTH VANDERPOEL AVE
Mailing Address - Street 2:SUITE B100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5153
Mailing Address - Country:US
Mailing Address - Phone:773-614-8784
Mailing Address - Fax:773-614-8171
Practice Address - Street 1:9303 SOUTH VANDERPOEL AVE
Practice Address - Street 2:SUITE B100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-5153
Practice Address - Country:US
Practice Address - Phone:773-614-8784
Practice Address - Fax:773-233-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1007525251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL861054799001Medicaid
IL147797Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER