Healthcare Provider Details

I. General information

NPI: 1649616129
Provider Name (Legal Business Name): PEKO HEALTHCARE AND CONSULTING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 E 87TH ST
CHICAGO IL
60619-6045
US

IV. Provider business mailing address

4986 GIBSON ST
MATTESON IL
60443-3023
US

V. Phone/Fax

Practice location:
  • Phone: 312-912-7672
  • Fax: 708-747-1343
Mailing address:
  • Phone: 773-912-7672
  • Fax: 708-747-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1011433
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number4000342
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000756
License Number StateIL

VIII. Authorized Official

Name: MR. SETH K OWUSU
Title or Position: PRESIDENT/AGENCY ADMINISTRATOR
Credential: MPH, MBA
Phone: 708-539-9014