Healthcare Provider Details

I. General information

NPI: 1720371008
Provider Name (Legal Business Name): GRANNY'S BLESSINGS HOMECARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12416 S HARLEM AVE SUITE 206
PALOS HEIGHTS IL
60463-1441
US

IV. Provider business mailing address

12416 S HARLEM AVE SUITE 206
PALOS HEIGHTS IL
60463-1441
US

V. Phone/Fax

Practice location:
  • Phone: 708-827-5434
  • Fax:
Mailing address:
  • Phone: 708-827-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4000276
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number3000522
License Number StateIL

VIII. Authorized Official

Name: MRS. MONSURAT A NWOKENKWO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 708-401-8769