Healthcare Provider Details

I. General information

NPI: 1841718640
Provider Name (Legal Business Name): STATEWIDE HEALTHCARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 GRAHAM ST SW
CULLMAN AL
35055-5238
US

IV. Provider business mailing address

1 N STATE ST STE 800
CHICAGO IL
60602-3312
US

V. Phone/Fax

Practice location:
  • Phone: 256-775-6655
  • Fax: 256-775-6443
Mailing address:
  • Phone: 800-404-3191
  • Fax: 312-704-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. LARRY J JENSEN
Title or Position: VICE PRESIDENT, OPERATIONS
Credential:
Phone: 800-404-3191