Healthcare Provider Details

I. General information

NPI: 1063653020
Provider Name (Legal Business Name): SOUTH SUBURBAN HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17055 HARLEM AVE
TINLEY PARK IL
60477-2739
US

IV. Provider business mailing address

17055 S. HARLEM AVE
TINLEY PARK IL
60477
US

V. Phone/Fax

Practice location:
  • Phone: 708-532-2273
  • Fax: 708-633-6100
Mailing address:
  • Phone: 708-532-2273
  • Fax: 708-633-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM HISEY PIERSON
Title or Position: PRESIDENT
Credential:
Phone: 708-532-2273