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General NPI Number Information
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NPI Number | 1588182455
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Entity Type | Organization
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Legal Business Name | STATEWIDE HEALTHCARE SERVICES, INC
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 80 ALI WAY
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City | OXFORD
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State | AL
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Zip | 36203-1835
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Country | US
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Telephone | 256-831-7146
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Fax | 256-831-2512
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Provider Business Mailing Address
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Address Line | 1 N STATE ST STE 800
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City | CHICAGO
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State | IL
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Zip | 60602-3312
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Country | US
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Telephone | 800-404-3191
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, OPERATIONS
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Name | MR. LARRY J JENSEN
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Credential |
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Telephone | 312-795-4683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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