Provider Demographics
NPI:1942377353
Name:STATSTAFF NURSES, PC
Entity Type:Organization
Organization Name:STATSTAFF NURSES, PC
Other - Org Name:STATSTAFF HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:630-682-0118
Mailing Address - Street 1:100 W ROOSEVELT RD
Mailing Address - Street 2:BUILDING B-5, SUITE 205
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5260
Mailing Address - Country:US
Mailing Address - Phone:630-682-0118
Mailing Address - Fax:630-682-0137
Practice Address - Street 1:100 W ROOSEVELT RD
Practice Address - Street 2:BUILDING B-5, SUITE 205
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5260
Practice Address - Country:US
Practice Address - Phone:630-682-0118
Practice Address - Fax:630-682-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL1010609251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1010609OtherHOME HEALTH LICENSE