MEDICARE: 3YS SERVICE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1598218604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3YS SERVICE, INC

Provider Business Mailing Address
First Line	:	914 E 54TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5018
Country	:	US
Telephone Number	:	708-334-6195
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 E 54TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5018
Country	:	US
Telephone Number	:	708-334-6195
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEMETRIS JANTUAH
Credential	:	RN, ALZ INSTR
Telephone Number	:	708-334-6195

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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