Healthcare Provider Details

I. General information

NPI: 1518110840
Provider Name (Legal Business Name): KINGSWAY HOME HEALTH SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7042 N MILWAUKEE AVE
NILES IL
60714-4423
US

IV. Provider business mailing address

7042 N MILWAUKEE AVE
NILES IL
60714-4423
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-8342
  • Fax: 773-761-3388
Mailing address:
  • Phone: 773-761-8342
  • Fax: 773-761-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1011014
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4000413
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000999
License Number StateIL

VIII. Authorized Official

Name: OLUBAYODE OLUWOLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 773-761-8342