Provider Demographics
NPI:1386517456
Name:ROSIE MAE HOME CARE, LLC-SUPPORTIVE LIVING
Entity type:Organization
Organization Name:ROSIE MAE HOME CARE, LLC-SUPPORTIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:TISHIEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-980-1020
Mailing Address - Street 1:220 FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2032
Mailing Address - Country:US
Mailing Address - Phone:708-980-1018
Mailing Address - Fax:866-630-3186
Practice Address - Street 1:220 FOREST BLVD
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466-2032
Practice Address - Country:US
Practice Address - Phone:708-980-1018
Practice Address - Fax:866-630-3186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSIE MAE HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities