Healthcare Provider Details

I. General information

NPI: 1588930549
Provider Name (Legal Business Name): A&V HOMECARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 CICERO AVE STE 2E
OAK FOREST IL
60452-1481
US

IV. Provider business mailing address

15000 CICERO AVE STE 2E
OAK FOREST IL
60452-1481
US

V. Phone/Fax

Practice location:
  • Phone: 708-535-4388
  • Fax: 708-535-8221
Mailing address:
  • Phone: 708-535-4388
  • Fax: 708-535-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. VICTOR OLUDARE SHOLANKE
Title or Position: ADMINISTRATOR
Credential: MSW, MS, QIDP
Phone: 708-535-4388