Healthcare Provider Details

I. General information

NPI: 1275895104
Provider Name (Legal Business Name): WEST SUBURBAN SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 BOHLAND AVE
BELLWOOD IL
60104-1833
US

IV. Provider business mailing address

439 BOHLAND AVENUE
BELLWOOD IL
60104
US

V. Phone/Fax

Practice location:
  • Phone: 708-547-5600
  • Fax: 708-547-0036
Mailing address:
  • Phone: 708-547-5600
  • Fax: 708-547-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL JENNINGS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PH.D.
Phone: 708-547-5600