Provider Demographics
NPI:1992888366
Name:AXIS HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:AXIS HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:LAGRIMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRONDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-685-0017
Mailing Address - Street 1:3242 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4732
Mailing Address - Country:US
Mailing Address - Phone:773-685-0017
Mailing Address - Fax:773-685-0269
Practice Address - Street 1:3242 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4732
Practice Address - Country:US
Practice Address - Phone:773-685-0017
Practice Address - Fax:773-685-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010339251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147792Medicare Oscar/Certification