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NPI 1649616129

NPI 1649616129 : PEKO HEALTHCARE AND CONSULTING SERVICES, INC. : CHICAGO, IL

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General NPI Number Information
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    NPI Number           |    1649616129
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    Entity Type          |    Organization 
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    Legal Business Name  |    PEKO HEALTHCARE AND CONSULTING SERVICES, INC. 
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Dates
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    Enumeration Date     |    05/10/2013
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    Last Update Date     |    05/10/2013
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Provider Practice Location Address
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    Address Line         |    526 E 87TH ST 
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    City                 |    CHICAGO
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    State                |    IL
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    Zip                  |    60619-6045
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    Country              |    US
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    Telephone            |    312-912-7672
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    Fax                  |    708-747-1343
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Provider Business Mailing Address
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    Address Line         |    4986 GIBSON ST 
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    City                 |    MATTESON
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    State                |    IL
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    Zip                  |    60443-3023
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    Country              |    US
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    Telephone            |    773-912-7672
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    Fax                  |    708-747-1343
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Authorized Official
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    Title or Position    |    PRESIDENT/AGENCY ADMINISTRATOR
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    Name                 |    MR. SETH K OWUSU 
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    Credential           |    MPH, MBA
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    Telephone            |    708-539-9014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    251F00000X
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    Taxonomy Name        |    Home Infusion Agency
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    License Number       |    4000342
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    License Number State |    IL
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Taxonomy #2
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    Taxonomy Code        |    253Z00000X
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    Taxonomy Name        |    In Home Supportive Care Agency
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    License Number       |    3000756
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    License Number State |    IL
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Taxonomy #3
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    Taxonomy Code        |    251E00000X
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    Taxonomy Name        |    Home Health Agency
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    License Number       |    1011433
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    License Number State |    IL
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