Provider Demographics
NPI:1346600467
Name:SPECIALIZED HOMECARE SERVICES
Entity type:Organization
Organization Name:SPECIALIZED HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CERTIFIED NURSE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JELKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-965-9758
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-0223
Mailing Address - Country:US
Mailing Address - Phone:708-965-9758
Mailing Address - Fax:
Practice Address - Street 1:19900 GOVERNORS DR
Practice Address - Street 2:SUITE 13
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1057
Practice Address - Country:US
Practice Address - Phone:708-663-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health