Provider Demographics
NPI:1740730001
Name:STATEWIDE HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:STATEWIDE HEALTHCARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:18004-043-1914
Mailing Address - Street 1:1 N STATE ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3302
Mailing Address - Country:US
Mailing Address - Phone:800-404-3191
Mailing Address - Fax:312-704-1126
Practice Address - Street 1:310 GRAHAM ST SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5238
Practice Address - Country:US
Practice Address - Phone:256-775-6655
Practice Address - Fax:312-704-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health