Provider Demographics
NPI:1134366552
Name:MEDICOSE HOME HEALTHCARE SVS,INC
Entity type:Organization
Organization Name:MEDICOSE HOME HEALTHCARE SVS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETORY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEFZAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-322-5960
Mailing Address - Street 1:7055 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2426
Mailing Address - Country:US
Mailing Address - Phone:773-262-8980
Mailing Address - Fax:773-262-8982
Practice Address - Street 1:940 INDIAN SPRING LN.
Practice Address - Street 2:
Practice Address - City:BUFFALOGROVE
Practice Address - State:IL
Practice Address - Zip Code:60089
Practice Address - Country:US
Practice Address - Phone:773-262-8980
Practice Address - Fax:773-262-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-350916251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health