Provider Demographics
NPI:1649616129
Name:PEKO HEALTHCARE AND CONSULTING SERVICES, INC.
Entity type:Organization
Organization Name:PEKO HEALTHCARE AND CONSULTING SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AGENCY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MBA
Authorized Official - Phone:708-539-9014
Mailing Address - Street 1:4986 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3023
Mailing Address - Country:US
Mailing Address - Phone:773-912-7672
Mailing Address - Fax:708-747-1343
Practice Address - Street 1:526 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6045
Practice Address - Country:US
Practice Address - Phone:312-912-7672
Practice Address - Fax:708-747-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000342251F00000X
IL3000756253Z00000X
IL1011433251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011433OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH: HOME HEALTH AGENCY
IL4000342OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH: HOME NURSING AGENCY
IL3000756OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH: HOME SERVICES AGENCY