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General NPI Number Information
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NPI Number | 1275895104
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Entity Type | Organization
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Legal Business Name | WEST SUBURBAN SENIOR SERVICES
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 439 BOHLAND AVE
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City | BELLWOOD
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State | IL
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Zip | 60104-1833
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Country | US
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Telephone | 708-547-5600
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Fax | 708-547-0036
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Provider Business Mailing Address
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Address Line | 439 BOHLAND AVENUE
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City | BELLWOOD
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State | IL
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Zip | 60104
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Country | US
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Telephone | 708-547-5600
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Fax | 708-547-0036
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. MICHAEL JENNINGS
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Credential | PH.D.
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Telephone | 708-547-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | IL
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