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General NPI Number Information
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NPI Number | 1942377353
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Entity Type | Organization
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Legal Business Name | STATSTAFF NURSES, PC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 W ROOSEVELT RD BUILDING B-5, SUITE 205
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City | WHEATON
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State | IL
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Zip | 60187-5260
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Country | US
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Telephone | 630-682-0118
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Fax | 630-682-0137
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Provider Business Mailing Address
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Address Line | 100 W ROOSEVELT RD BUILDING B-5, SUITE 205
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City | WHEATON
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State | IL
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Zip | 60187-5260
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Country | US
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Telephone | 630-682-0118
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Fax | 630-682-0137
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES EUGENE WILSON JR.
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Credential | PRESIDENT
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Telephone | 630-682-0118
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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 | IL1010609
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License Number State | IL
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